Rapid decreases of key antioxidant molecules in critically ill patients: A personalized approach

Abstract

Oxidative stress is regarded a key component of critical illness and has been associated with poor prognosis in Intensive Care Unit (ICU) patients. Diverse antioxidant treatments have been applied to combat oxidative stress in ICU, yet the results were typically disappointing. An explanation for this failure is that all studies utilized antioxidants indiscriminately and did not take into account the antioxidant profile of the patients. The aim of the present study was to investigate whether critically ill patients experience different insufficiencies in three major antioxidants with a "recycling" redox relationship (vitamin C, vitamin E and glutathione) and in the central reductant molecule of many enzymatic antioxidants (NADPH). Sixty mechanically-ventilated adult medical critically ill patients (age: 63.5±17.1; APACHE II score: 21.2±7.4; Glasgow Coma Scale: 6.2±1.9) were enrolled in the study, while 20 healthy age-matched volunteers served as control group. The antioxidant profile and the level of systemic oxidative stress (F2-isoprostanes) were measured at ICU admission and at days 1 and 7. The majority of the ICU patients developed rapid and severe antioxidant insufficiencies (by exhibiting less than 50% of the control values) in one (22/60), two (7/60) or three (2/60) of the antioxidants measured, despite the almost similar levels of oxidative stress. The wide heterogeneity in antioxidant decreases in response to ICU stay highlights the importance of patient stratification when planning to apply antioxidant treatments and indicates that the successful delivery of personalized clinical nutrition may depend on our ability to identify "responsive" phenotypes.