Abstract
The main objective of this pilot study was to determine the association between augmented renal clearance (ARC), urinary nitrogen loss and muscle wasting in critically ill trauma patients. We conducted a retrospective analysis of a local database in 162 critically ill trauma patients without chronic renal dysfunction. Nutritional-related parameters and 24 h urinary biochemical analyses were prospectively collected and averaged over the first ten days after admission. Augmented renal clearance was defined by a mean creatinine clearance (CLCR) > 130 mL/min/1.73 m2. The main outcome was the cumulated nitrogen balance at day 10. The secondary outcome was the variation of muscle psoas cross-sectional area (ΔCSA) calculated in the subgroup of patients who underwent at least two abdominal CT scans during the ICU length of stay. Overall, there was a significant correlation between mean CLCR and mean urinary nitrogen loss (normalized coefficient: 0.47 ± 0.07, p < 0.0001). ARC was associated with a significantly higher urinary nitrogen loss (17 ± 5 vs. 14 ± 4 g/day, p < 0.0001) and a lower nitrogen balance (−6 ± 5 vs. −4 ± 5 g/day, p = 0.0002), without difference regarding the mean protein intake (0.7 ± 0.2 vs. 0.7 ± 0.3 g/kg/day, p = 0.260). In the subgroup of patients who underwent a second abdominal CT scan (N = 47), both ΔCSA and %ΔCSA were higher in ARC patients (−33 [−41; −25] vs. −15 [−29; −5] mm2/day, p = 0.010 and −3 [−3; −2] vs. −1 [−3; −1] %/day, p = 0.008). Critically ill trauma patients with ARC are thus characterized by a lower nitrogen balance and increased muscle loss over the 10 first days after ICU admission. The interest of an increased protein intake (>1.5 g/kg/day) in such patients remains a matter of controversy and must be confirmed by further randomized trials.
Highlights
Marked protein catabolism is considered of paramount importance during critical illness, especially in severe trauma patients [1]
This pilot study is a retrospective analysis of our local database prospectively collected over a 20-month period (January 2019 to September 2020) in every critically ill trauma patient admitted in our 25-bed Surgical and Trauma Intensive Care Unit (ICU)
Critically ill trauma patients with augmented renal clearance (ARC) were characterized by a lower nitrogen balance and an increased muscle loss despite receiving a similar protein intake over the 10 first days after ICU admission
Summary
Marked protein catabolism is considered of paramount importance during critical illness, especially in severe trauma patients [1]. Targeted protein intake is thought to improve short-term outcome, reduce muscle wasting and hospital mortality [2,3]. Determination of nitrogen balance is one of the most common methods to assess muscle catabolism and determine the targeted protein requirement [4,5]. Critically ill trauma patients often experience augmented renal clearance (ARC), defined by an enhanced creatinine clearance (CLCR) exceeding 130 mL/min/1.73 m2 and responsible for an increased excretion of solutes and urinary eliminated medications [6]. Whether ARC is an adaptive response to acute aggression and/or a predisposing factor for further renal damage remains to be determined [9,10]
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