title: Glutamine and glutathione at ICU admission in relation to outcome.
abstract: Glutamine depletion is demonstrated to be an independent predictor of hospital mortality in ICU (intensive care unit) patients. Today glutamine supplementation is recommended to ICU patients on parenteral nutrition. In addition to glutamine, glutathione may be a limiting factor in ICU patients with MOF (multiple organ failure). To study the prevalence of glutamine and glutathione depletion an observational study was performed. The results were analysed in relation to mortality and the conventional predictors of mortality outcome, APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment). Consecutive patients admitted to the ICU at Karolinska University Hospital Huddinge were studied. Patient admission scoring of APACHE II and SOFA were registered as well as mortality up to 6 months. Plasma glutamine concentration and whole blood glutathione status at admittance were analysed. The admission plasma glutamine concentrations were totally independent of the conventional risk scoring at admittance, and a subnormal concentration was an independent predictor of mortality. In addition, glutathione redox status was also an independent mortality predictor, but here a normal ratio was the risk factor. In both cases the mortality risk was mainly confined to the post-ICU period. A low plasma concentration of glutamine at ICU admission is an independent risk factor for post-ICU mortality. The possible benefit of extending glutamine supplementation post-ICU should be evaluated prospectively.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine at Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: Paul Castillo
authors.initials: PC
authors.lastname: Rodas
authors.forename: Olav
authors.initials: O
authors.lastname: Rooyackers
authors.forename: Christina
authors.initials: C
authors.lastname: Hebert
authors.forename: Åke
authors.initials: Å
authors.lastname: Norberg
authors.forename: Jan
authors.initials: J
authors.lastname: Wernerman
mesh_terms: D018806:APACHE; D000368:Aged; D005260:Female; D005973:Glutamine / Q000378:metabolism*; D005978:Glutathione / Q000378:metabolism*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000401:mortality*; D010343:Patient Admission; D012306:Risk; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D005973:Glutamine; D005978:Glutathione