title: [Citrulline and arginine kinetics and its value as a prognostic factor in pediatric critically ill patients].
abstract: BACKGROUND
  Low concentrations of plasma citrulline and arginine have been reported in children under various pathological conditions.
  
  
  OBJECTIVE
  Plasma citrulline and arginine levels undergo different kinetics during the early days of critical illness in children according to the severity of symptoms and can be correlated with other clinical and laboratory parameters associated with the SIR.
  
  
  METHODS
  A single-center prospective observational study in patients 7 days to 14 years admitted to pediatric intensive care unit (PICU). Citrulline and arginine blood levels (blood in dry paper, analysis by mass spectrometry in tandem), acute phase reactants and clinical data were collected on admission, at 12 h, 24 h, 3 and 7 days.
  
  
  RESULTS
  A total of 44 critically ill patients were included and control group was formed by 42 healthy children. The citrulline and arginine kinetic analysis showed: 1) Citrulline falls significantly (P<.05) at 12 h of admission; levels remain low until day 7 and begin progressive increase again. 2) Arginine is already lowered at 6h, although an earlier rise occurs (3rd day). 3. The decrease of citrulline in the first 3 days of admission positively correlates with arginine kinetics. Bivariate analysis showed: 1) Correlation of elevated citrulline on the 7th day with shorter duration of mechanical ventilation, lower PICU stay and lower occurrence of complications. The levels of citrulline still descended at day 7 are associated with increased CRP/procalcitonin elevation at first 24 h. 2) The greatest decrease of arginine in the first 12 h is associated with a longer PICU stay and greater number of complications and increase of acute phase reactants at 3 days.
  
  
  CONCLUSIONS
  There are decreased levels of arginine and citrulline in the first days at PICU, with recovery at the 3rd and 7th day respectively, and a relationship between a greater decrease and a worse outcome and between a longer income and a higher serum CRP/procalcitonin.
authors.affiliation: Sección de Gastroenterología, Hepatología, y Nutrición Infantil, Servicio de Pediatría, Hospital Materno-Infantil, Málaga, España. Electronic address: javierblascoalonso@yahoo.es.
authors.forename: J
authors.initials: J
authors.lastname: Blasco-Alonso
authors.affiliation: Sección de Cuidados Críticos y Urgencias Pediátricas, Hospital Materno-Infantil, Málaga, España.
authors.forename: P
authors.initials: P
authors.lastname: SánchezYáñez
authors.affiliation: Sección de Cuidados Críticos y Urgencias Pediátricas, Hospital Materno-Infantil, Málaga, España.
authors.forename: V
authors.initials: V
authors.lastname: Rosa Camacho
authors.affiliation: Sección de Cuidados Críticos y Urgencias Pediátricas, Hospital Materno-Infantil, Málaga, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Camacho Alonso
authors.affiliation: Servicio de Laboratorio, Hospital Carlos Haya, Málaga, España.
authors.forename: R
authors.initials: R
authors.lastname: Yahyaoui Macías
authors.affiliation: Sección de Cuidados Críticos y Urgencias Pediátricas, Hospital Materno-Infantil, Málaga, España.
authors.forename: R
authors.initials: R
authors.lastname: Gil-Gómez
authors.affiliation: Sección de Cuidados Críticos y Urgencias Pediátricas, Hospital Materno-Infantil, Málaga, España; Grupo IBIMA Pediatría Integral.
authors.forename: G
authors.initials: G
authors.lastname: Milano Manso
mesh_terms: D000293:Adolescent; D001120:Arginine / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D002956:Citrulline / Q000097:blood*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007700:Kinetics; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood*; D013997:Time Factors
chemical_list: D002956:Citrulline; D001120:Arginine
keywords: Arginina; Arginine; Citrulina; Citrulline; Critical illness; Enfermedad crítica; Paediatrics; Pediatría; Systemic inflammatory response syndrome; Síndrome de respuesta inflamatoria sistémica