title: Plasma L-citrulline concentrations and its relationship with inflammation at the onset of septic shock: a pilot study.
abstract: OBJECTIVE
  Hypocitrullinemia has been suggested to be a prognostic factor for patients in intensive care. The aim of this ancillary study of the Corticosteroids and Intensive Insulin Therapy for Septic Shock prospective study was to investigate plasma L-citrulline concentrations and its relationship with inflammation and digestive bacterial translocation in patients with septic shock multiorgan failure and without primary intestinal disease or chronic renal failure.
  
  
  METHODS
  Sixteen adult patients were selected. They were studied on day (D) 0 at hours (H) 0, 6, 12, 18, and 24 and on D4 (H96). Selected plasma amino acids and proteins, proinflammatory (tumor necrosis factor α [TNF-α]) and anti-inflammatory (interleukin [IL] 10) cytokine concentrations, and bacterial translocation were measured.
  
  
  RESULTS
  Eight D14 survivors and 8 D14 nonsurvivors patients were studied. Citrulline was decreased on D0 (H0: 29 ± 10 vs nadir: 18 ± 6 μmol/L; P < .05). The citrulline nadir was lower (P < .01) in patients with digestive bacterial translocation than that in those without. Mean citrulline concentrations at H0 to H96 were not significantly different between survivors and nonsurvivors. In both groups, citrulline was significantly inversely correlated with C-reactive protein (r(2) = 0.10, P < .01) on D0. No significant correlations were found between citrulline and albumin, transthyretin, TNF-α, IL-10, or TNF-α/IL-10 ratio.
  
  
  CONCLUSIONS
  At the onset of septic shock, plasma citrulline decreases and varies inversely with C-reactive protein and is lower when digestive bacterial translocation occurs. This finding could reflect an early acute intestinal dysfunction, but measurement of citrulline concentration does not appear to be able to predict the patients' mortality.
authors.affiliation: Université de Versailles Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Département de Médecine aiguë spécialisée and EA 4497, Hôpital Raymond-Poincaré, Garches, France. Electronic address: pascal.crenn@rpc.aphp.fr.
authors.forename: Pascal
authors.initials: P
authors.lastname: Crenn
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Service de Biochimie, Groupe Hospitalier Cochin-Hôtel-Dieu, Paris, France; Université Paris Descartes, Faculté de Pharmacie, Laboratoire de Nutrition, EA 4466, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Neveux
authors.affiliation: INSERM-UMR S717, Université Paris Diderot, Assistance Publique-Hôpitaux de Paris, Biostatistiques et Informatique médicale, Hôpital Saint-Louis, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Service de Biochimie, Groupe Hospitalier Cochin-Hôtel-Dieu, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jaffray
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Service de Biochimie, Groupe Hospitalier Cochin-Hôtel-Dieu, Paris, France; Université Paris Descartes, Faculté de Pharmacie, Laboratoire de Nutrition, EA 4466, Paris, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Cynober
authors.affiliation: Université de Versailles Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Département de Médecine aiguë spécialisée and EA 4497, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Melchior
authors.affiliation: Université de Versailles Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Réanimation and EA 4342, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
mesh_terms: D000418:Albumins / Q000032:analysis; D018988:Bacterial Translocation; D002097:C-Reactive Protein / Q000032:analysis; D002956:Citrulline / Q000097:blood*; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000401:mortality; D010865:Pilot Projects; D011228:Prealbumin / Q000032:analysis; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood* / Q000382:microbiology / Q000401:mortality; D017741:Survivors; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D000418:Albumins; D016207:Cytokines; D015850:Interleukin-6; D011228:Prealbumin; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002956:Citrulline; D002097:C-Reactive Protein
keywords: Citrulline; Enterocytes; Intensive care unit; Plasma cytokines; Septic shock