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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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Post-ICU plasma glutamine concentrations of patients (n = 49), admitted to the ICU and given exogenous intravenous glutamine supplementation together with full nutrition for >3 days. Patients were sampled on their last day of ICU stay (during ongoing intravenous supplementation) and thereafter every 5 to 7 days during the remaining hospital stay. All patients are depicted in (A). The reference interval used in the study, 400 to 930 μmol/L is indicated by gray shading. (B) only illustrates patients who were not readmitted to ICU (n = 35), where the nonsurvivors at 12 months (n = 7) are shown as red lines. (C) illustrates patients who were readmitted to the ICU (n = 14), nonsurvivors at 12 months (n = 8) are shown as red lines. Thick lines illustrate periods during which patients in this subgroup were again given intravenous glutamine supplementation during full feeding. ICU, intensive care unit.
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Fig2: Post-ICU plasma glutamine concentrations of patients (n = 49), admitted to the ICU and given exogenous intravenous glutamine supplementation together with full nutrition for >3 days. Patients were sampled on their last day of ICU stay (during ongoing intravenous supplementation) and thereafter every 5 to 7 days during the remaining hospital stay. All patients are depicted in (A). The reference interval used in the study, 400 to 930 μmol/L is indicated by gray shading. (B) only illustrates patients who were not readmitted to ICU (n = 35), where the nonsurvivors at 12 months (n = 7) are shown as red lines. (C) illustrates patients who were readmitted to the ICU (n = 14), nonsurvivors at 12 months (n = 8) are shown as red lines. Thick lines illustrate periods during which patients in this subgroup were again given intravenous glutamine supplementation during full feeding. ICU, intensive care unit.

Mentions: In study A (the post-ICU temporal pattern of plasma glutamine concentrations) patients were included between October 19, 2011 and June 11, 2012 (Figure 1A). Sixty-three patients were included to reach the target, which resulted in 49 patients who could be evaluated for their post-ICU plasma glutamine concentrations. For patient characteristics see Table 1, and for ICU discharge, total amino acids and glutamine concentrations see Table 2. Figure 2 shows the plasma glutamine concentration in each patient. In subpanels B and C patients are divided into (i) those who were readmitted or not readmitted to ICU, and (ii) survivors and nonsurvivors. The glutamine supplementation periods are indicated for readmitted patients. In total, 210 post-ICU samples were collected: 6 were <400 μmol/L and 16 were >930 μmol/L. Values outside these limits have been shown to be associated with an increased mortality risk at ICU admission [2]. At discharge from the ICU, plasma glutamine concentration dropped in 30 out of 49 patients from 690 (532,818) to 622 (506,765) μmol/L (P = 0.054).Table 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)

Post-ICU plasma glutamine concentrations of patients (n = 49), admitted to the ICU and given exogenous intravenous glutamine supplementation together with full nutrition for >3 days. Patients were sampled on their last day of ICU stay (during ongoing intravenous supplementation) and thereafter every 5 to 7 days during the remaining hospital stay. All patients are depicted in (A). The reference interval used in the study, 400 to 930 μmol/L is indicated by gray shading. (B) only illustrates patients who were not readmitted to ICU (n = 35), where the nonsurvivors at 12 months (n = 7) are shown as red lines. (C) illustrates patients who were readmitted to the ICU (n = 14), nonsurvivors at 12 months (n = 8) are shown as red lines. Thick lines illustrate periods during which patients in this subgroup were again given intravenous glutamine supplementation during full feeding. 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

Fig2: Post-ICU plasma glutamine concentrations of patients (n = 49), admitted to the ICU and given exogenous intravenous glutamine supplementation together with full nutrition for >3 days. Patients were sampled on their last day of ICU stay (during ongoing intravenous supplementation) and thereafter every 5 to 7 days during the remaining hospital stay. All patients are depicted in (A). The reference interval used in the study, 400 to 930 μmol/L is indicated by gray shading. (B) only illustrates patients who were not readmitted to ICU (n = 35), where the nonsurvivors at 12 months (n = 7) are shown as red lines. (C) illustrates patients who were readmitted to the ICU (n = 14), nonsurvivors at 12 months (n = 8) are shown as red lines. Thick lines illustrate periods during which patients in this subgroup were again given intravenous glutamine supplementation during full feeding. ICU, intensive care unit.
Mentions: In study A (the post-ICU temporal pattern of plasma glutamine concentrations) patients were included between October 19, 2011 and June 11, 2012 (Figure 1A). Sixty-three patients were included to reach the target, which resulted in 49 patients who could be evaluated for their post-ICU plasma glutamine concentrations. For patient characteristics see Table 1, and for ICU discharge, total amino acids and glutamine concentrations see Table 2. Figure 2 shows the plasma glutamine concentration in each patient. In subpanels B and C patients are divided into (i) those who were readmitted or not readmitted to ICU, and (ii) survivors and nonsurvivors. The glutamine supplementation periods are indicated for readmitted patients. In total, 210 post-ICU samples were collected: 6 were <400 μmol/L and 16 were >930 μmol/L. Values outside these limits have been shown to be associated with an increased mortality risk at ICU admission [2]. At discharge from the ICU, plasma glutamine concentration dropped in 30 out of 49 patients from 690 (532,818) to 622 (506,765) μmol/L (P = 0.054).Table 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