title: Argininemia and plasma arginine bioavailability - predictive factors of mortality in the severe trauma patients?
abstract: BACKGROUND
  Arginine is an amino acid determinant in the metabolic, immune and reparative responses to severe trauma. The present study aims to determine argininemia and plasma arginine bioavailability (PAB) in critical trauma patients and to analyze its correlation with prognosis.
  
  
  METHODS
  A prospective study of 23 critical trauma patients was undertaken. Aminoacidemias were determined, by ion exchange chromatography, at admission and in the first and third days and compared with those of 11 healthy individuals. PAB was calculated. Severity indexes and outcome parameters were recorded.
  
  
  RESULTS
  Values of argininemia, citrullinemia and ornithinemia at the admission were significantly lower than those of the controls (arginine: 41.2 ± 20.6 versus 56.1 ± 11.9 μmol/L, P = 0.034). Hipoargininemia (<60 μmol/L) prevalence was 82.6 %. Mean PAB was 62.4 ± 25.6 %. Argininemia < 26 μmol/L constituted a significant predictive factor of in-hospital mortality [n = 4 (17.4 %); 75 versus 15.8 %, P = 0.04; odds ratio = 4.7; accuracy = 87 %] and lower actuarial survival (63.5 ± 43.9 versus 256.1 ± 33.3 days, P = 0.031). PAB <42 % [n = 6 (26.1 %)] was associated with higher lactacidemia levels (P = 0.033), higher in-hospital mortality (66.7 versus 11.8 %, P = 0.021; odds ratio = 5.7, accuracy = 82.6 %) and lower actuarial survival (87.2 ± 37.5 versus 261.4 ± 34.7 days, n.s.). Probability of in-hospital mortality was inversely and significantly related with PAB [61.8 ± 8.8 % (95 % CI 50.8-72.7) when PAB <41 % and 2.8 ± 1.9 % (95 % CI 1.9-8.3) when PAB > 81 %, P = 0.0001]. Charlson's index ≥1, APACHE II ≥19.5, SOFA ≥7.5, and glutaminemia < 320 μmol/L were also predictive factors of actuarial survival.
  
  
  CONCLUSIONS
  Those results confirm the high prevalence of arginine depletion in severe trauma patients and the relevance of argininemia and PAB as predictive factors of mortality in this context.
authors: "A" Surgical Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal ; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors: Beatriz P
authors: BP
authors: Costa
authors: Faculty of Medicine, University of Coimbra, Coimbra, Portugal ; Intensive Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors: Paulo
authors: P
authors: Martins
authors: Genetic Biochemistry Department, Center for Neurosciences and Cellular Biology of Coimbra University, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors: Carla
authors: C
authors: Veríssimo
authors: Genetic Biochemistry Department, Center for Neurosciences and Cellular Biology of Coimbra University, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors: Marta
authors: M
authors: Simões
authors: "A" Surgical Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
authors: Marisa
authors: M
authors: Tomé
authors: Genetic Biochemistry Department, Center for Neurosciences and Cellular Biology of Coimbra University, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors: Manuela
authors: M
authors: Grazina
authors: Faculty of Medicine, University of Coimbra, Coimbra, Portugal ; Intensive Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors: Jorge
authors: J
authors: Pimentel
authors: "A" Surgical Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal ; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors: Francisco
authors: F
authors: Castro-Sousa
keywords: Arginine; Critically ill patients; Mortality; Plasma arginine bioavailability; Trauma