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Plasma glutamine concentration after intensive care unit discharge: an observational study.

Smedberg M, Grass JN, Pettersson L, Norberg Å, Rooyackers O, Wernerman J - Crit Care (2014)

Bottom Line: Low plasma glutamine concentration at ICU admission is associated with unfavorable outcomes.Post-ICU glutamine levels are not indicative of glutamine depletion.The relation between plasma glutamine concentration and glutamine availability during critical illness is not well understood, and needs to be studied further to define the possible role for glutamine supplementation.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Low plasma glutamine concentration at ICU admission is associated with unfavorable outcomes. The prediction of plasma glutamine concentration after ICU discharge on outcomes has not been characterized. In the recent Scandinavian Glutamine Trial, a survival advantage was seen with glutamine supplementation as long as patients stayed in the ICU. It was therefore hypothesized that the glutamine level may drop at ICU discharge, indicative of a sustained glutamine deficiency, which may be related to outcome.

Methods: Fully fed ICU patients intravenously supplemented with glutamine for >3 days were studied at ICU discharge and post ICU. In study A, plasma glutamine level was followed every 5 to 7 days post ICU of the remaining hospital stay and compared to the level on the day of ICU discharge (n=63). In study B, plasma glutamine level 24 to 72 hours after ICU discharge was related to 12-month all-cause mortality (n=100).

Results: Post-ICU plasma glutamine levels were within normal range and were not found to be predictive for mortality outcome. Plasma glutamine level at discharge, on the other hand, was within normal limits but higher in nonsurvivors. In addition, it was adding prediction value to discharge SOFA scores for post-ICU mortality.

Conclusions: Post-ICU glutamine levels are not indicative of glutamine depletion. The relation between plasma glutamine concentration and glutamine availability during critical illness is not well understood, and needs to be studied further to define the possible role for glutamine supplementation.

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CONSORT diagrams on patients screened and included in the studies. Patients admitted to the ICU) and given exogenous intravenous glutamine supplementation together with full nutrition for >3 days were eligible. (A) describes patients sampled on their last day of ICU stay and thereafter every 5 to 7 days during the remaining hospital stay. Mortality, dropouts and ICU readmissions are indicated. (B) describes patients discharged from the ICU and sampled 24 to 72 hours after discharge. Mortality and dropouts are indicated. ICU, intensive care unit.
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Fig1: CONSORT diagrams on patients screened and included in the studies. Patients admitted to the ICU) and given exogenous intravenous glutamine supplementation together with full nutrition for >3 days were eligible. (A) describes patients sampled on their last day of ICU stay and thereafter every 5 to 7 days during the remaining hospital stay. Mortality, dropouts and ICU readmissions are indicated. (B) describes patients discharged from the ICU and sampled 24 to 72 hours after discharge. Mortality and dropouts are indicated. ICU, intensive care unit.

Mentions: The unit has 12 beds and is the only ICU at the Huddinge wing of Karolinska University Hospital, which includes transplant surgery, major gastrointestinal surgery, hematology and infectious diseases, but not cardiac surgery, trauma care and neurosurgery. The protocol was to include consecutive patients admitted to the general ICU at Karolinska University Hospital Huddinge, who received iv glutamine supplement for >3 days. Exclusion criteria were: age <18, restrains of treatment, absence of informed consent, and readmissions to the ICU. Patients already in the study continued their enrollment according to protocol - if they were readmitted. Figure 1 contains CONSORT diagrams on patient recruitment. Before obtaining patients’ written informed consent, patients (or next of kin) were informed verbally and in writing about the study and possible risks. The Regional Ethics Committee in Stockholm approved the protocol, which complied with the Helsinki Declaration.Figure 1


Plasma glutamine concentration after intensive care unit discharge: an observational study.

Smedberg M, Grass JN, Pettersson L, Norberg Å, Rooyackers O, Wernerman J - Crit Care (2014)

CONSORT diagrams on patients screened and included in the studies. Patients admitted to the ICU) and given exogenous intravenous glutamine supplementation together with full nutrition for >3 days were eligible. (A) describes patients sampled on their last day of ICU stay and thereafter every 5 to 7 days during the remaining hospital stay. Mortality, dropouts and ICU readmissions are indicated. (B) describes patients discharged from the ICU and sampled 24 to 72 hours after discharge. Mortality and dropouts are indicated. ICU, intensive care unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4300616&req=5

Fig1: CONSORT diagrams on patients screened and included in the studies. Patients admitted to the ICU) and given exogenous intravenous glutamine supplementation together with full nutrition for >3 days were eligible. (A) describes patients sampled on their last day of ICU stay and thereafter every 5 to 7 days during the remaining hospital stay. Mortality, dropouts and ICU readmissions are indicated. (B) describes patients discharged from the ICU and sampled 24 to 72 hours after discharge. Mortality and dropouts are indicated. ICU, intensive care unit.
Mentions: The unit has 12 beds and is the only ICU at the Huddinge wing of Karolinska University Hospital, which includes transplant surgery, major gastrointestinal surgery, hematology and infectious diseases, but not cardiac surgery, trauma care and neurosurgery. The protocol was to include consecutive patients admitted to the general ICU at Karolinska University Hospital Huddinge, who received iv glutamine supplement for >3 days. Exclusion criteria were: age <18, restrains of treatment, absence of informed consent, and readmissions to the ICU. Patients already in the study continued their enrollment according to protocol - if they were readmitted. Figure 1 contains CONSORT diagrams on patient recruitment. Before obtaining patients’ written informed consent, patients (or next of kin) were informed verbally and in writing about the study and possible risks. The Regional Ethics Committee in Stockholm approved the protocol, which complied with the Helsinki Declaration.Figure 1

Bottom Line: Low plasma glutamine concentration at ICU admission is associated with unfavorable outcomes.Post-ICU glutamine levels are not indicative of glutamine depletion.The relation between plasma glutamine concentration and glutamine availability during critical illness is not well understood, and needs to be studied further to define the possible role for glutamine supplementation.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Low plasma glutamine concentration at ICU admission is associated with unfavorable outcomes. The prediction of plasma glutamine concentration after ICU discharge on outcomes has not been characterized. In the recent Scandinavian Glutamine Trial, a survival advantage was seen with glutamine supplementation as long as patients stayed in the ICU. It was therefore hypothesized that the glutamine level may drop at ICU discharge, indicative of a sustained glutamine deficiency, which may be related to outcome.

Methods: Fully fed ICU patients intravenously supplemented with glutamine for >3 days were studied at ICU discharge and post ICU. In study A, plasma glutamine level was followed every 5 to 7 days post ICU of the remaining hospital stay and compared to the level on the day of ICU discharge (n=63). In study B, plasma glutamine level 24 to 72 hours after ICU discharge was related to 12-month all-cause mortality (n=100).

Results: Post-ICU plasma glutamine levels were within normal range and were not found to be predictive for mortality outcome. Plasma glutamine level at discharge, on the other hand, was within normal limits but higher in nonsurvivors. In addition, it was adding prediction value to discharge SOFA scores for post-ICU mortality.

Conclusions: Post-ICU glutamine levels are not indicative of glutamine depletion. The relation between plasma glutamine concentration and glutamine availability during critical illness is not well understood, and needs to be studied further to define the possible role for glutamine supplementation.

Show MeSH