title: L-arginine and asymmetric dimethylarginine are early predictors for survival in septic patients with acute liver failure.
abstract: Dysfunctions of the L-arginine (L-arg)/nitric-oxide (NO) pathway are suspected to be important for the pathogenesis of multiple organ dysfunction syndrome (MODS) in septic shock. Therefore plasma concentrations of L-arg and asymmetric dimethylarginine (ADMA) were measured in 60 patients with septic shock, 30 surgical patients and 30 healthy volunteers using enzyme linked immunosorbent assay (ELISA) kits. Plasma samples from patients with septic shock were collected at sepsis onset, and 24 h, 4 d, 7 d, 14 d and 28 d later. Samples from surgical patients were collected prior to surgery, immediately after the end of the surgical procedure as well as 24 h later and from healthy volunteers once. In comparison to healthy volunteers and surgical patients, individuals with septic shock showed significantly increased levels of ADMA, as well as a decrease in the ratio of L-arg and ADMA at all timepoints. In septic patients with an acute liver failure (ALF), plasma levels of ADMA and L-arg were significantly increased in comparison to septic patients with an intact hepatic function. In summary it can be stated, that bioavailability of NO is reduced in septic shock. Moreover, measurements of ADMA and L-arg appear to be early predictors for survival in patients with sepsis-associated ALF.
authors.affiliation: Department of Anesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. thorsten.brenner@med.uni-heidelberg.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Brenner
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Fleming
authors.forename: Claudia
authors.initials: C
authors.lastname: Rosenhagen
authors.forename: Ute
authors.initials: U
authors.lastname: Krauser
authors.forename: Markus
authors.initials: M
authors.lastname: Mieth
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.forename: Eike
authors.initials: E
authors.lastname: Martin
authors.forename: Peter P
authors.initials: PP
authors.lastname: Nawroth
authors.forename: Markus A
authors.initials: MA
authors.lastname: Weigand
authors.forename: Angelika
authors.initials: A
authors.lastname: Bierhaus
authors.forename: Stefan
authors.initials: S
authors.lastname: Hofer
mesh_terms: D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood; D009569:Nitric Oxide / Q000378:metabolism; D012372:ROC Curve; D018805:Sepsis / Q000097:blood*; D012772:Shock, Septic / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009569:Nitric Oxide; C018524:N,N-dimethylarginine; D001120:Arginine