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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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Plasma glutamine concentrations in ICU patients given exogenous intravenous glutamine supplementation together with full nutrition for >3 days and who were discharged alive from ICU, in relation to 12-month, post-ICU mortality. (A) illustrates discharge glutamine level (n = 63), and (B) illustrates glutamine levels 24 to 72 hours post discharge (n = 92). Discharge glutamine level during ongoing intravenous supplementation but not post-ICU glutamine level was associated with mortality outcome. Gray shading indicates the reference interval used, 400 to 930 μmol/L. Horizontal lines indicate median values. ICU, intensive care unit.
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Fig3: Plasma glutamine concentrations in ICU patients given exogenous intravenous glutamine supplementation together with full nutrition for >3 days and who were discharged alive from ICU, in relation to 12-month, post-ICU mortality. (A) illustrates discharge glutamine level (n = 63), and (B) illustrates glutamine levels 24 to 72 hours post discharge (n = 92). Discharge glutamine level during ongoing intravenous supplementation but not post-ICU glutamine level was associated with mortality outcome. Gray shading indicates the reference interval used, 400 to 930 μmol/L. Horizontal lines indicate median values. ICU, intensive care unit.

Mentions: Regarding the samples collected during ongoing iv glutamine supplementation on the last day of ICU stay all 63 patients were evaluated (Tables 1 and 3a,b), there was a difference between 12-month survivors and nonsurvivors, 596 (491,744) versus 777 (648,848) μmol/L (P = 0.004) respectively (Figure 3A). There was also a difference in the sequential organ failure assessment (SOFA score on the last day of ICU stay 3 (2,5) versus 7 (4,9) (P = 0.0003). Using univariate logistic regression analysis, discharge SOFA score, admission simplified acute physiology score III (SAPS III) score, dialysis, and discharge plasma glutamine concentration were identified as mortality predictors (Table 3a). The stepwise regression analysis indicated that at discharge, the discharge SOFA score complemented the discharge plasma glutamine concentration and enabled the best mortality prediction (Table 3b).Table 3


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)

Plasma glutamine concentrations in ICU patients given exogenous intravenous glutamine supplementation together with full nutrition for >3 days and who were discharged alive from ICU, in relation to 12-month, post-ICU mortality. (A) illustrates discharge glutamine level (n = 63), and (B) illustrates glutamine levels 24 to 72 hours post discharge (n = 92). Discharge glutamine level during ongoing intravenous supplementation but not post-ICU glutamine level was associated with mortality outcome. Gray shading indicates the reference interval used, 400 to 930 μmol/L. Horizontal lines indicate median values. 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

Fig3: Plasma glutamine concentrations in ICU patients given exogenous intravenous glutamine supplementation together with full nutrition for >3 days and who were discharged alive from ICU, in relation to 12-month, post-ICU mortality. (A) illustrates discharge glutamine level (n = 63), and (B) illustrates glutamine levels 24 to 72 hours post discharge (n = 92). Discharge glutamine level during ongoing intravenous supplementation but not post-ICU glutamine level was associated with mortality outcome. Gray shading indicates the reference interval used, 400 to 930 μmol/L. Horizontal lines indicate median values. ICU, intensive care unit.
Mentions: Regarding the samples collected during ongoing iv glutamine supplementation on the last day of ICU stay all 63 patients were evaluated (Tables 1 and 3a,b), there was a difference between 12-month survivors and nonsurvivors, 596 (491,744) versus 777 (648,848) μmol/L (P = 0.004) respectively (Figure 3A). There was also a difference in the sequential organ failure assessment (SOFA score on the last day of ICU stay 3 (2,5) versus 7 (4,9) (P = 0.0003). Using univariate logistic regression analysis, discharge SOFA score, admission simplified acute physiology score III (SAPS III) score, dialysis, and discharge plasma glutamine concentration were identified as mortality predictors (Table 3a). The stepwise regression analysis indicated that at discharge, the discharge SOFA score complemented the discharge plasma glutamine concentration and enabled the best mortality prediction (Table 3b).Table 3

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