title: Prevalence of glutamine deficiency in ICU patients: a cross-sectional analytical study.
abstract: Not only is glutamine deficiency an independent predictor of mortality in intensive care unit (ICU) patients, but glutamine supplementation is also recommended for its proven outcome benefits. However, recent data suggest that early glutamine supplementation in certain patient groups increase mortality. The aim of this study was to investigate plasma glutamine levels of adult ICU patients in the South African setting and to determine relationships between glutamine levels, gender, diagnostic categories and selected inflammatory markers. The data from this study will be used as baseline measurement to support a large scale study that will be undertaken in the South African ICU population.
  
  
  
  This cross-sectional, analytical study included 60 mixed adult ICU patients within 24 h post ICU admission. Plasma glutamine levels were determined on admission. The relationship between glutamine levels, Interleukin-6 (IL-6) and C-reactive protein (CRP); as well as gender- and diagnosis-related differences in glutamine levels were also investigated. A non-parametric ROC curve was computed to determine the CRP concentration cut-off point above which glutamine becomes deficient.
  
  
  
  The median plasma glutamine level (497 μmol/L) was in the normal range; however, 38.3 % (n = 23) of patients had deficient (<420 μmol/L) and 6.7 % (n = 4) had supra-normal glutamine levels (>930 μmol/L). No significant difference could be detected between glutamine levels and gender or diagnosis categories as a group. When only the medical and surgical categories were compared, the median plasma glutamine level of the medical patients were significantly lower than that of the surgical patients (p = 0.042). Glutamine showed inverse associations with CRP levels (r = -0.44, p < 0.05) and IL-6 concentrations (r = -0.23, p = 0.08). A CRP cut-off value of 95.5 mg/L was determined above which glutamine levels became deficient.
  
  
  
  About a third of patients (38 %) were glutamine deficient on admission to ICU, whereas some presented with supra-normal levels. While glutamine levels correlated inversely with inflammatory markers, and a CRP value of above 95.5 mg/L indicated potential glutamine deficiency, the clinical application of this finding needs further investigation.
authors.affiliation: Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, Potchefstroom, South Africa.
authors.forename: Arista
authors.initials: A
authors.lastname: Nienaber
authors.affiliation: Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, Potchefstroom, South Africa.
authors.forename: Robin Claire
authors.initials: RC
authors.lastname: Dolman
authors.affiliation: Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, Potchefstroom, South Africa.
authors.forename: Averalda Eldorine
authors.initials: AE
authors.lastname: van Graan
authors.affiliation: Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, South Africa. rb@sun.ac.za.
authors.forename: Renee
authors.identifier: 0000-0001-7413-5918
authors.initials: R
authors.lastname: Blaauw
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003422:Critical Care; D003430:Cross-Sectional Studies; D005260:Female; D005973:Glutamine / Q000097:blood / Q000172:deficiency*; D006801:Humans; D007249:Inflammation / Q000097:blood; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D013019:South Africa
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D005973:Glutamine; D002097:C-Reactive Protein
keywords: C-reactive protein; Gender; Glutamine; Intensive care unit; Interleukin-6