title: Whole blood glutathione status and ICU morbidity in critically ill children.
abstract: BACKGROUND
  A high reduced glutathione ratio is associated with high mortality in adult ICU patients. Whole blood glutathione status in critically ill children is less well characterized. In this study, whole blood glutathione status in pediatric intensive care (PICU) patients was determined and the relation between the redox status of whole blood glutathione and morbidity was investigated.
  
  
  METHODS
  A prospective consecutive cohort of critically ill children (n = 146) admitted to the PICU of a tertiary university hospital, and a reference group of healthy children (n = 60) and healthy adults (n = 10) were included in the study. The concentrations of total and reduced whole blood were determined at admission and patient characteristics were recorded.
  
  
  RESULTS
  A high fraction of reduced glutathione in the glutathione redox status was associated with longer dependency of mechanical ventilation and length of stay in the PICU (P = 0.02 and P = 0.03 respectively). In patients with a prolonged stay in the PICU (> 5 days), a more reduced state of glutathione was seen in patients who had more than two organ failures as compared to patients with one or two failing organs (P < 0.01 and P < 0.05), respectively. A positive correlation was also seen between numbers of organ failures and redox status of glutathione (r  = 0.45, P < 0.001).
  
  
  CONCLUSIONS
  A high reduced glutathione ratio was associated with longer PICU stay, duration of mechanical ventilation, and multiple organ failure.
authors.affiliation: Department of Anaesthesia and Intensive Care at Astrid Lindgren Children's Hospital at Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.|Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Fläring
authors.affiliation: Department of Anaesthesia and Intensive Care at Astrid Lindgren Children's Hospital at Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.|Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Ekmark
authors.affiliation: Department of Anaesthesia and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden.|Centre For Surgical Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Wernerman
authors.affiliation: Department of Anaesthesia and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden.|Centre For Surgical Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Rooyackers
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D005978:Glutathione / Q000097:blood*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D009017:Morbidity; D009102:Multiple Organ Failure / Q000378:metabolism; D011446:Prospective Studies
chemical_list: D005978:Glutathione