title: Assessment of asymmetrical dimethylarginine metabolism in patients with critical illness.
abstract: BACKGROUND
  Critically ill patients experience metabolic disorders including hypercatabolic state and hyperglycaemia, and these are associated with poor outcome. Hyperglycaemia and asymmetrical dimethylarginine (ADMA) are reported to have significant influences on endothelial dysfunction. The aim of this study was to examine the relationship between plasma ADMA and related arginine metabolism in patients with critical illness.
  Two venous blood samples (EDTA) (104 patients), on admission and follow-up sample in the last day in intensive care unit (ICU) (died or discharge sample median 7, interquartile range (IQR) 6-8, range 5-15). Plasma ADMA, arginine, homoarginine and SDMA were measured by high-performance liquid chromatography (HPLC).
  
  
  RESULTS
  ADMA (P < 0·01) and SDMA (P < 0·05) were elevated, and homoarginine was decreased (P < 0·05) in nonsurvivors and was directly associated with predicted mortality rate (P < 0·05 and P < 0·001), Sequential Organ Failure Assessment (SOFA) (P < 0·05, P < 0·001), ICU stay (P < 0·05, P < 0·001) and mortality (P < 0·01, P < 0·05). ADMA was directly associated with SDMA (P < 0·001), albumin (P < 0·05), ICU stay and mortality (P < 0·01). SDMA was directly associated with creatinine (P < 0·001) and Acute physiology and Chronic Health Evaluation II score (P < 0·001). In the follow-up measurements, there was a significant decrease in SOFA score (P < 0·01), homoarginine (P < 0·01), aminotransferase (P < 0·01), Laboratory Glucose (P < 0·01) and albumin (P < 0·01). In contrast, there was an increase in arginine (P < 0·01), ADMA (P < 0·01), ADMA:SDMA ratio (P < 0·01) and the norepinephrine administration (P < 0·01).
  
  
  CONCLUSIONS
  In the present longitudinal study, ADMA metabolism was altered in patients with critical illness and was associated with disease severity and mortality.
authors.affiliation: Academic Unit of Anaesthesia, College of Medical, Veterinary and Life of Sciences - University of Glasgow, Royal Infirmary, Glasgow, UK.|Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences - University of Glasgow, Royal Infirmary, Glasgow, UK.
authors.forename: Rawia A
authors.initials: RA
authors.lastname: Ghashut
authors.affiliation: Department of Biochemistry, The Scottish Trace Element and Micronutrient Reference Laboratory, Royal Infirmary, Glasgow, UK.
authors.forename: Scott
authors.initials: S
authors.lastname: Blackwell
authors.affiliation: Department of Biochemistry, The Scottish Trace Element and Micronutrient Reference Laboratory, Royal Infirmary, Glasgow, UK.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Ryan
authors.affiliation: Department of Biochemistry, The Scottish Trace Element and Micronutrient Reference Laboratory, Royal Infirmary, Glasgow, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Willox
authors.affiliation: Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences - University of Glasgow, Royal Infirmary, Glasgow, UK.
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
authors.affiliation: Academic Unit of Anaesthesia, College of Medical, Veterinary and Life of Sciences - University of Glasgow, Royal Infirmary, Glasgow, UK.
authors.forename: John
authors.initials: J
authors.lastname: Kinsella
authors.affiliation: Department of Biochemistry, The Scottish Trace Element and Micronutrient Reference Laboratory, Royal Infirmary, Glasgow, UK.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Talwar
mesh_terms: D000328:Adult; D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000378:metabolism; D002851:Chromatography, High Pressure Liquid; D003422:Critical Care; D016638:Critical Illness; D004730:Endothelium, Vascular / Q000502:physiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: C487735:dimethylarginine; D001120:Arginine
keywords: Arginine; asymmetrical dimethylarginine; critical illness; homoarginine; symmetrical dimethylarginine