Abstract
BackgroundNot only is glutamine deficiency an independent predictor of mortality in intensive care unit (ICU) patients, but glutamine supplementation is also recommended for its proven outcome benefits. However, recent data suggest that early glutamine supplementation in certain patient groups increase mortality. The aim of this study was to investigate plasma glutamine levels of adult ICU patients in the South African setting and to determine relationships between glutamine levels, gender, diagnostic categories and selected inflammatory markers. The data from this study will be used as baseline measurement to support a large scale study that will be undertaken in the South African ICU population.MethodsThis cross-sectional, analytical study included 60 mixed adult ICU patients within 24 h post ICU admission. Plasma glutamine levels were determined on admission. The relationship between glutamine levels, Interleukin-6 (IL-6) and C-reactive protein (CRP); as well as gender- and diagnosis-related differences in glutamine levels were also investigated. A non-parametric ROC curve was computed to determine the CRP concentration cut-off point above which glutamine becomes deficient.ResultsThe median plasma glutamine level (497 μmol/L) was in the normal range; however, 38.3 % (n = 23) of patients had deficient (<420 μmol/L) and 6.7 % (n = 4) had supra-normal glutamine levels (>930 μmol/L). No significant difference could be detected between glutamine levels and gender or diagnosis categories as a group. When only the medical and surgical categories were compared, the median plasma glutamine level of the medical patients were significantly lower than that of the surgical patients (p = 0.042). Glutamine showed inverse associations with CRP levels (r = −0.44, p < 0.05) and IL-6 concentrations (r = −0.23, p = 0.08). A CRP cut-off value of 95.5 mg/L was determined above which glutamine levels became deficient.ConclusionsAbout a third of patients (38 %) were glutamine deficient on admission to ICU, whereas some presented with supra-normal levels. While glutamine levels correlated inversely with inflammatory markers, and a CRP value of above 95.5 mg/L indicated potential glutamine deficiency, the clinical application of this finding needs further investigation.
Highlights
Is glutamine deficiency an independent predictor of mortality in intensive care unit (ICU) patients, but glutamine supplementation is recommended for its proven outcome benefits
The inability to demonstrate a difference between the groups was possibly related to the statistical power, as very few trauma patients were admitted to the ICUs during the study period
When excluding the two trauma patients, a significantly lower median glutamine level was found in the medical patient group compared to the surgical group (p = 0.042)
Summary
Is glutamine deficiency an independent predictor of mortality in intensive care unit (ICU) patients, but glutamine supplementation is recommended for its proven outcome benefits. Previous studies showed decreased levels of plasma and muscle glutamine in selected critically ill, post-surgical, Glutamine supplementation has been extensively studied for its contribution to the improvement of patient outcomes. Until recently, it has been deemed safe and effective in a variety of patient groups, including the Nienaber et al Nutrition Journal (2016) 15:73 severely ill, burns and surgical patient [6,7,8,9]. Outcome benefits such as reductions in length of hospital stay (LOHS), length of ICU stay, mortality risk and infectious complications, as well as an improvement in nitrogen balance, was previously reported, depending on the specific patient group as well as the dose and route of administration [6,7,8,9]
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