College of Medicine and Public Health, Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia; Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.
College of Medicine and Public Health, Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia; Department of Critical Care Medicine, Flinders University, Bedford Park, South Australia, Australia.
Nitric Oxide. 2022 May 1;122-123:47-53. doi: 10.1016/j.niox.2022.03.002. Epub 2022 Mar 31.
Arginine metabolites are associated with cardiovascular and all-cause mortality in several patient groups. We investigated whether arginine metabolites are associated with mortality in patients with critical illness and whether associations are independent of other factors affecting prognosis in an Intensive Care Unit (ICU).
1155 acutely unwell adult patients admitted to a mixed medical-surgical ICU were studied. Arginine, asymmetric dimethyl-l-arginine (ADMA), monomethyl-l-arginine (MMA), symmetric dimethyl-l-arginine (SDMA) and l-homoarginine were measured in a plasma sample collected at admission to ICU by liquid chromatography tandem mass spectrometry. Risk of death score was calculated using data submitted to the Australia and New Zealand Intensive Care Society.
In this cohort, 163 patients (14.1%) died. ADMA (odds ratio = 1.159 (1.033-1.300) per 0.1 μmol/L increment, p = 0.012), homoarginine (odds ratio = 0.963 (0.934-0.992), p = 0.013) and risk of death score (odds ratio = 1.045 (1.037-1.053) per 1% increment, p < 0.001) were independently associated with mortality in ICU patients. The area under the receiver operator characteristic curve for risk of death score, ADMA and homoarginine combined for mortality was greater than for risk of death score alone (0.815 (95% CI 0.790-0.837) vs 0.796 (95% CI 0.781-0.820), p = 0.019). Other arginine metabolites were not independently associated with mortality.
ADMA is positively and homoarginine negatively associated with mortality in ICU patients, independent of other clinical factors. Measuring ADMA and homoarginine may refine models to predict ICU mortality. Reducing ADMA and increasing homoarginine are potential therapeutic targets to reduce mortality in critically ill patients.
精氨酸代谢物与心血管疾病和多种患者群体的全因死亡率相关。我们研究了精氨酸代谢物是否与危重病患者的死亡率相关，以及这些关联是否独立于影响重症监护病房 (ICU) 预后的其他因素。
研究了 1155 名急性入住混合内科-外科 ICU 的成年患者。通过液相色谱串联质谱法在 ICU 入院时采集的血浆样本中测量精氨酸、不对称二甲基-l-精氨酸 (ADMA)、单甲基-l-精氨酸 (MMA)、对称二甲基-l-精氨酸 (SDMA) 和 l-同型精氨酸。使用提交给澳大利亚和新西兰重症监护学会的数据计算死亡风险评分。
在该队列中，163 名患者 (14.1%) 死亡。ADMA (比值比 = 1.159 (1.033-1.300)，每增加 0.1 μmol/L，p = 0.012)、同型精氨酸 (比值比 = 0.963 (0.934-0.992)，p = 0.013) 和死亡风险评分 (比值比 = 1.045 (1.037-1.053)，每增加 1%，p < 0.001) 与 ICU 患者的死亡率独立相关。死亡风险评分、ADMA 和同型精氨酸联合用于死亡率的受试者工作特征曲线下面积大于死亡风险评分单独使用的面积 (0.815 (95%CI 0.790-0.837) 与 0.796 (95%CI 0.781-0.820)，p = 0.019)。其他精氨酸代谢物与死亡率无独立相关性。
ADMA 与 ICU 患者的死亡率呈正相关，同型精氨酸与死亡率呈负相关，独立于其他临床因素。测量 ADMA 和同型精氨酸可能会改进预测 ICU 死亡率的模型。降低 ADMA 和增加同型精氨酸可能是降低危重病患者死亡率的潜在治疗靶点。
