title: Taurine Concentrations Decrease in Critically Ill Patients With Shock Given Enteral Nutrition.
abstract: BACKGROUND
  Nutrition studies in the intensive care unit (ICU) have shown that adequate enteral nutrition (EN) support has clinical benefits. However, the course of amino acid concentrations in plasma has never been investigated in patients admitted with shock receiving EN. We hypothesized that plasma concentrations, when deficit, increase during EN and that persistent deficiency is associated with poor outcome.
  
  
  METHODS
  In 33 septic or cardiogenic shock patients receiving EN, plasma amino acid concentrations were measured during 5 days. Changes in amino acid concentrations, correlations with clinical outcome variables, and regression analyses were studied.
  
  
  RESULTS
  On ICU admission, several plasma concentrations were deficient. Plasma concentrations of almost all amino acids increased. In contrast, taurine decreased by >50%, from 47.6 µmol/L on admission to 20.0 µmol/L at day 1, and remained low at day 5. Taurine (admission) correlated with time on mechanical ventilation (R = -0.42, P = .015). Taurine decrease within 24 hours correlated with Acute Physiology and Chronic Health Evaluation II predicted mortality (R = 0.43, P = .017) and Sequential Organ Failure Assessment score (R = 0.36, P = .05). Regression analyses confirmed correlations.
  
  
  CONCLUSIONS
  Several amino acids were deficient in plasma on ICU admission but increased during EN. Taurine concentrations declined and were associated with longer periods of mechanical ventilation and ICU support. Fast taurine decline correlated with severity of organ failure. These findings support the role of taurine during ischemia, reperfusion, and inflammation. Taurine may be an essential candidate to enrich nutrition support for critically ill patients, although more research is required.
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mechteld A R
authors.initials: MA
authors.lastname: Vermeulen
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Mireille F M
authors.initials: MF
authors.lastname: van Stijn
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands Department of Cardio-thoracic Surgery, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marlieke
authors.initials: M
authors.lastname: Visser
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Stéphanie M P
authors.initials: SM
authors.lastname: Lemmens
authors.affiliation: Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands.
authors.forename: Alexander P J
authors.initials: AP
authors.lastname: Houdijk
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Paul A M
authors.initials: PA
authors.lastname: van Leeuwen
authors.affiliation: Intensive Care Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands Intensive Care Unit, VU University Medical Center, Amsterdam, The Netherlands h.oudemans@vumc.nl.
authors.forename: Heleen M
authors.initials: HM
authors.lastname: Oudemans-van Straaten
mesh_terms: D018806:APACHE; D000596:Amino Acids / Q000097:blood; D016638:Critical Illness / Q000628:therapy; D004750:Enteral Nutrition; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010865:Pilot Projects; D011446:Prospective Studies; D012121:Respiration, Artificial; D012770:Shock, Cardiogenic / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy*; D013654:Taurine / Q000008:administration & dosage / Q000097:blood*
chemical_list: D000596:Amino Acids; D013654:Taurine
keywords: ICU; amino acids; arginine; cardiogenic shock; glutamine; protein; sepsis