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. 2012 Jun;122(12):591-7.
doi: 10.1042/CS20110520.

Glutamine and glutathione at ICU admission in relation to outcome

Paul Castillo Rodas  1 , Olav Rooyackers, Christina Hebert, Åke Norberg, Jan Wernerman
Affiliations

Glutamine and glutathione at ICU admission in relation to outcome

Paul Castillo Rodas et al. Clin Sci (Lond). 2012 Jun.

Abstract

Glutamine depletion is demonstrated to be an independent predictor of hospital mortality in ICU (intensive care unit) patients. Today glutamine supplementation is recommended to ICU patients on parenteral nutrition. In addition to glutamine, glutathione may be a limiting factor in ICU patients with MOF (multiple organ failure). To study the prevalence of glutamine and glutathione depletion an observational study was performed. The results were analysed in relation to mortality and the conventional predictors of mortality outcome, APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment). Consecutive patients admitted to the ICU at Karolinska University Hospital Huddinge were studied. Patient admission scoring of APACHE II and SOFA were registered as well as mortality up to 6 months. Plasma glutamine concentration and whole blood glutathione status at admittance were analysed. The admission plasma glutamine concentrations were totally independent of the conventional risk scoring at admittance, and a subnormal concentration was an independent predictor of mortality. In addition, glutathione redox status was also an independent mortality predictor, but here a normal ratio was the risk factor. In both cases the mortality risk was mainly confined to the post-ICU period. A low plasma concentration of glutamine at ICU admission is an independent risk factor for post-ICU mortality. The possible benefit of extending glutamine supplementation post-ICU should be evaluated prospectively.

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Figures

Figure 1
Figure 1. A CONSORT diagram illustrating the screening of all admitted patient during the study period
Non-included patients were divided into <24 h of ICU stay, with a mortality of 34% and>24 h of ICU stay with a mortality of 52%. The latter group had an ICU stay of 4 (3, 7) days (values is the median and interquartile range).
Figure 2
Figure 2. All-cause 6-month mortality (open bars) and ICU mortality (filled bars) of consecutive patients admitted to the general ICU (n=174) at Karolinska Huddinge divided into quartiles according to the admittance plasma glutamine concentration
Mortality is different in between the quartiles, where the two lower quartiles are different from the two higher (P=0.037).
Figure 3
Figure 3. Relationship between the plasma concentration of glutamine of consecutive patients admitted to the general ICU (n=174) at Karolinska Huddinge and their APACHE II scores
No correlation was seen (P=0.46)
Figure 4
Figure 4. Relationship between the GSH/total glutathione ratio in whole blood reduced of consecutive patients admitted to the general ICU (n=169) at Karolinska Huddinge compared with their APACHE II scores
No correlation was seen (P=0.93).
Figure 5
Figure 5. All-cause 6-month mortality (open bars) and ICU mortality (filled bars) of consecutive patients admitted to the general ICU (n=169) at Karolinska Huddinge divided into quartiles according to the GSH/total glutathione (tGSH) ratio of whole blood at admittance reflecting glutathione redox status
Mortality is different in between the quartiles, where the highest quartile is different from the three lower (P=0.026).
Figure 6
Figure 6. Simulation of the additional prediction of mortality rate from an out of range glutamine concentration at admittance
Black line is the APACHE-predicted mortality rate if the plasma glutamine concentration at admittance is within the range 400–930 μmol/l. With an admittance glutamine concentration outside of that range, the dotted curve represents the predicted mortality rate, suggesting a mortality rate of 50% at APACHE 20 in contrast with APACHE 29.5 if the glutamine concentration is not considered.
Figure 7
Figure 7. Individual plasma glutamine concentrations at ICU admission compared with outcome
Note the log-scale of the y-axis. Grey area represents normal values 400–930 μM. Median in each group is depicted as a line.
See this image and copyright information in PMC

References

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