Intensive Care Unit, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece; Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece.
School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Greece.
Clin Nutr. 2020 Apr;39(4):1146-1154. doi: 10.1016/j.clnu.2019.04.029. Epub 2019 Apr 29.
BACKGROUND & AIMS: Oxidative stress is regarded a key component of critical illness and has been associated with poor prognosis in Intensive Care Unit (ICU) patients. Diverse antioxidant treatments have been applied to combat oxidative stress in ICU, yet the results were typically disappointing. An explanation for this failure is that all studies utilized antioxidants indiscriminately and did not take into account the antioxidant profile of the patients. The aim of the present study was to investigate whether critically ill patients experience different insufficiencies in three major antioxidants with a "recycling" redox relationship (vitamin C, vitamin E and glutathione) and in the central reductant molecule of many enzymatic antioxidants (NADPH).
Sixty mechanically-ventilated adult medical critically ill patients (age: 63.5 ± 17.1; APACHE II score: 21.2 ± 7.4; Glasgow Coma Scale: 6.2 ± 1.9) were enrolled in the study, while 20 healthy age-matched volunteers served as control group. The antioxidant profile and the level of systemic oxidative stress (F-isoprostanes) were measured at ICU admission and at days 1 and 7.
The majority of the ICU patients developed rapid and severe antioxidant insufficiencies (by exhibiting less than 50% of the control values) in one (22/60), two (7/60) or three (2/60) of the antioxidants measured, despite the almost similar levels of oxidative stress.
The wide heterogeneity in antioxidant decreases in response to ICU stay highlights the importance of patient stratification when planning to apply antioxidant treatments and indicates that the successful delivery of personalized clinical nutrition may depend on our ability to identify "responsive" phenotypes.
氧化应激被认为是危重病的一个关键组成部分，并与重症监护病房（ICU）患者的预后不良相关。在 ICU 中，已经应用了多种抗氧化治疗来对抗氧化应激，但结果通常令人失望。对此失败的一种解释是，所有研究都不加区分地使用抗氧化剂，并且没有考虑患者的抗氧化剂谱。本研究的目的是调查危重病患者是否在三种具有“循环”氧化还原关系的主要抗氧化剂（维生素 C、维生素 E 和谷胱甘肽）以及许多酶抗氧化剂的中心还原剂分子（NADPH）中经历不同的不足。
本研究纳入了 60 名接受机械通气的成年重症医学科危重病患者（年龄：63.5±17.1；APACHE II 评分：21.2±7.4；格拉斯哥昏迷评分：6.2±1.9），同时纳入 20 名年龄匹配的健康志愿者作为对照组。在 ICU 入院时以及第 1 天和第 7 天测量了抗氧化剂谱和系统氧化应激水平（F-异前列烷）。
尽管氧化应激水平几乎相似，但大多数 ICU 患者在一种（22/60）、两种（7/60）或三种（2/60）测量的抗氧化剂中迅速且严重地出现抗氧化不足（表现为低于对照组值的 50%）。
对 ICU 入住期间抗氧化剂降低的广泛异质性突出了在计划应用抗氧化治疗时对患者进行分层的重要性，并表明成功实施个性化临床营养可能取决于我们识别“有反应”表型的能力。
