Buter Hanneke, Bakker Andries J, Kingma W Peter, Koopmans Matty, Boerma E Christiaan
Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Department of Clinical Chemistry, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
BMC Anesthesiol. 2016 Mar 10;16:15. doi: 10.1186/s12871-016-0180-7.
A low plasma glutamine level at the time of acute admission to the intensive care unit (ICU) is an independent predictor of an unfavourable outcome in critically ill patients. The primary objective of this study was to determine whether there are differences in plasma glutamine levels upon non-elective or elective ICU admission. The secondary objective was to compare glutamine levels over time, and to determine correlations between glutamine levels and the severity of illness and presence of infection in ICU patients.
We performed a single-centre observational study in a closed-format, 22-bed, mixed ICU. Plasma glutamine levels were measured at admission and every morning at 6.00 a.m. during the ICU stay. We aimed to include at least 80 patients per group. The study was approved by the local Medical Ethics Committee.
In 88 patients after elective surgery, the median plasma glutamine level at admission was significantly higher compared with that in 90 non-elective patients (0.43 mmol/l [0.33-0.55 mmol/l] versus 0.25 mmol/l [0.09-0.37 mmol/l], P = 0.001). During the ICU stay, plasma glutamine levels remained significantly higher in elective patients than in non-elective patients. There was a significant correlation between the APACHE IV score and glutamine levels (R = 0.52, P < 0.001). Moreover, backward linear regression analysis showed that this correlation was independently associated with the APACHE IV score and the presence of infection, but not with the type of admission.
Plasma glutamine levels are significantly lower after non-elective admission compared with elective admission to the ICU. A considerable amount of elective and non-elective patients have decreased plasma glutamine levels, but this is not independently associated with the type of admission. In contrast to previous studies, we found that plasma glutamine levels were determined by the severity of illness and the presence of an infection.
ClinicalTrials.gov, number NCT02310035.
重症监护病房（ICU）急性入院时血浆谷氨酰胺水平低是危重症患者不良预后的独立预测因素。本研究的主要目的是确定非选择性或选择性ICU入院时血浆谷氨酰胺水平是否存在差异。次要目的是比较不同时间点的谷氨酰胺水平，并确定ICU患者谷氨酰胺水平与疾病严重程度和感染情况之间的相关性。
我们在一家拥有22张床位的封闭式混合ICU进行了一项单中心观察性研究。在入院时以及ICU住院期间每天早上6点测量血浆谷氨酰胺水平。我们的目标是每组至少纳入80例患者。该研究获得了当地医学伦理委员会的批准。
88例择期手术后患者入院时血浆谷氨酰胺水平中位数显著高于90例非择期患者（0.43 mmol/L[0.33 - 0.55 mmol/L]对0.25 mmol/L[0.09 - 0.37 mmol/L]，P = 0.001）。在ICU住院期间，择期患者的血浆谷氨酰胺水平仍显著高于非择期患者。急性生理与慢性健康状况评分系统（APACHE）IV评分与谷氨酰胺水平之间存在显著相关性（R = 0.52，P < 0.001）。此外，向后线性回归分析表明，这种相关性与APACHE IV评分和感染情况独立相关，但与入院类型无关。
与选择性入住ICU相比，非选择性入住后血浆谷氨酰胺水平显著降低。相当数量的选择性和非选择性患者血浆谷氨酰胺水平降低，但这与入院类型无独立相关性。与先前的研究不同，我们发现血浆谷氨酰胺水平由疾病严重程度和感染情况决定。
美国国立医学图书馆临床试验注册库，编号NCT02310035。
