LOW PLASMA GLUTAMINE LEVELS IN SEVERE ACUTE PANCREATITIS JUSTIFY GLUTAMINE SUBSTITUTION IN CRITICALLY ILL PANCREATITIS PATIENTS

Abstract

Glutamine stabilizes intestinal barrier function and has been shown to reduce bacterial translocation in acute experimental pancreatitis. Glutamine infusions are frequently given to critically ill patients, but in the case of acute pancreatitis, there so far has been little evidence to justify this treatment. Our aim was to assess the prognostic value of plasma glutamine levels in acute pancreatitis and to establish a rationale for glutamine substitution in these patients. Patients and Methods: Plasma glutamine levels were measured both on admission and after 72 hours in 26 patients with a first attack of acute pancreatitis. They were then considered in the context of the following parameters: age, gender, etiology, smoking, body mass index, pain intensity, guarding and rebound tenderness, APACHE-II score on admission, Ranson and Imrie scores (72 hours) as well as the result of a contrast-enhanced computed tomography (CT; Balthazar score) within 72 hours. The association between plasma glutamine levels and patient characteristics was determined using the mean value recorded on admission (384 μmol/l plasma) as the cut-off value. Results: Low levels on admission were associated only with increased intensity of pain (p = 0.026). Low levels after 72 hours were associated with old age (≥60 years; p = 0.016), increased intensity of pain (p = 0.016), rebound tenderness on admission (p = 0.005), and with a Ranson score ≥4 points (p = 0.016). A decrease of plasma glutamine levels between admission and day 3 was associated with old age (p = 0.026), biliary pancreatitis (p = 0.026), intensity of pain on admission (p = 0.049), Balthazar E4 (p = 0.034), and with both the Ranson and the Imrie score (p = 0.0076; p = 0.0147). Conclusion: Plasma glutamine levels are decreased in severe pancreatitis which justifies glutamine substitution in such patients when either enteral or parenteral nutrition is indicated.