Glutaminemia prognostic significance in critical surgical patients - An analysis of plasma aminogram profile

• Autor(a) principal: Costa, Beatriz Pinto
• Data de Publicação: 2017
• Outros Autores: Martins, Paulo, Veríssimo, Carla, Simões, Marta, Tomé, Marisa, Grazina, Manuela, Pimentel, Jorge, Sousa, Francisco Castro
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10316/108292; https://doi.org/10.20960/nh.817
• topic: Glutaminemia; Plasma aminogram; Critical patients; Surgery; Prognosis; Glutaminemia; Plasma aminograma; Pacientes críticos; Cirugía; Prognosi; Adult; Aged; Aged, 80 and over; Critical Care; Critical Illness; Female; Glutamine; Hospital Mortality; Humans; Male; Middle Aged; Patients; Prospective Studies; Respiration, Artificial; Young Adult

Background: Glutamine depletion is common in the critically-ill patients. Glutaminemia lower than 420 μmol/l has been considered as an independent predictive factor of mortality, but the indications for exogenous glutamine supplementation remain controversial. This study intends to determine the glutaminemia profi le in critical surgical patients and to investigate its correlation with the severity indexes and the prognosis. Methods: A prospective study of 28 adult critical surgical patients was performed. Plasma amino acid concentrations were quantifi ed, by ion exchange chromatography, at the moment of admission and at the fi rst and third days, and compared with those of 11 reference healthy individuals. Severity indexes and parameters of prognosis were registered. Results: In critical surgical patients, mean glutaminemia at admission was lower than that of control individuals (385.1 ± 123.1 versus 515 ± 57.9 μmol/l, p = 0.002) and decreased until the third day (p = 0.042). Prevalence of severe hypoglutaminemia (< 420 μmol/l) at admission was 64.3%. Baseline glutaminemia correlated with the Simplifi ed Acute Physiology Score II (SAPS II score) (Pearson’s correlation coeffi cient r = -39.4%, p = 0.042), and it was lower in cases of erythrocytes transfusion (339.9 ± 78.8 versus 454.9 ± 148.8 μmol/l, p = 0.013). Glutaminemia at the third day correlated with the duration of invasive ventilation support (r = -65%, p = 0 .012) and ICU stay (r = -66.5%, p = 0.009). Glutaminemia below 320 μmol/l, observed in 25% of the patients, was associated with higher in-hospital mortality (42.9 versus 19%, statistically not signifi cant [n.s.]) and lower actuarial survival (212.1 ± 77.9 versus 262.3 ± 32.4 days, n.s.). Conclusions: Those results underscore the relevance of hypoglutaminemia as an adverse predictive factor in the critical surgical patients. Determination of glutaminemia may contribute to a better defi nition of the indications for glutamine supplementation.