Abstract
IntroductionCritically ill patients suffer from oxidative stress caused by reactive oxygen species (ROS) and reactive nitrogen species (RNS). Although ROS/RNS are constantly produced under normal circumstances, critical illness can drastically increase their production. These patients have reduced plasma and intracellular levels of antioxidants and free electron scavengers or cofactors, and decreased activity of the enzymatic system involved in ROS detoxification. The pro-oxidant/antioxidant balance is of functional relevance during critical illness because it is involved in the pathogenesis of multiple organ failure. In this study the objective was to evaluate the relation between oxidative stress in critically ill patients and antioxidant vitamin intake and severity of illness.MethodsSpectrophotometry was used to measure in plasma the total antioxidant capacity and levels of lipid peroxide, carbonyl group, total protein, bilirubin and uric acid at two time points: at intensive care unit (ICU) admission and on day seven. Daily diet records were kept and compliance with recommended dietary allowance (RDA) of antioxidant vitamins (A, C and E) was assessed.ResultsBetween admission and day seven in the ICU, significant increases in lipid peroxide and carbonyl group were associated with decreased antioxidant capacity and greater deterioration in Sequential Organ Failure Assessment score. There was significantly greater worsening in oxidative stress parameters in patients who received antioxidant vitamins at below 66% of RDA than in those who received antioxidant vitamins at above 66% of RDA. An antioxidant vitamin intake from 66% to 100% of RDA reduced the risk for worsening oxidative stress by 94% (ods ratio 0.06, 95% confidence interval 0.010 to 0.39), regardless of change in severity of illness (Sequential Organ Failure Assessment score).ConclusionThe critical condition of patients admitted to the ICU is associated with worsening oxidative stress. Intake of antioxidant vitamins below 66% of RDA and alteration in endogenous levels of substances with antioxidant capacity are related to redox imbalance in critical ill patients. Therefore, intake of antioxidant vitamins should be carefully monitored so that it is as close as possible to RDA.
Highlights
Ill patients suffer from oxidative stress caused by reactive oxygen species (ROS) and reactive nitrogen species (RNS)
An antioxidant vitamin intake from 66% to 100% of recommended dietary allowance (RDA) reduced the risk for worsening oxidative stress by 94%, regardless of change in severity of illness (Sequential Organ Failure Assessment score)
There was a significantly greater mean difference in Sequential Organ Failure Assessment (SOFA) score between admission and day seven in the group with antioxidant vitamin intake below 66% of RDA, whereas there was no difference between groups in days on mechanical ventilation, mortality, length at intensive care unit (ICU) stay or nutritional variables
Summary
Ill patients suffer from oxidative stress caused by reactive oxygen species (ROS) and reactive nitrogen species (RNS). ROS/RNS are constantly produced under normal circumstances, critical illness can drastically increase their production These patients have reduced plasma and intracellular levels of antioxidants and free electron scavengers or cofactors, and decreased activity of the enzymatic system involved in ROS detoxification. Ill patients have reduced plasma and intracellular levels of antioxidants and free electron scavengers or cofactors, and decreased activity of the enzymatic system that is involved in ROS detoxification [5]. The pro-oxidant/antioxidant balance is of functional relevance during critical illness because it is involved in the pathogenesis of multiple organ failure [6,7,8,9]. The antioxidant capacity (AOC) of patients with sepsis may be compromised by increased utilization of plasmabinding proteins as part of the acute inflammatory response and by inadequate nutrition [8]
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