Organ Failure In Patients Research Articles

HMGB-1 as a Useful Prognostic Biomarker in Sepsis-Induced Organ Failure in Patients Undergoing PMX-DHP

High mobility group box 1 (HMGB-1) has recently received attention as a late mediator of lipopolysaccharide-induced shock, and is thought to function as a mediator in such a disorder as multi-organ failure (MOF). In Japan, we have access to an immobilized polymyxin B fiber column using a direct hemoperfusion (PMX-DHP) for patients with septic shock to improve hemodynamics and organ dysfunction. In this study, we looked at HMGB-1 levels in each category based on the sequential organ failure assessment (SOFA) scores to further dissect its importance in specific aspects of organ failure in patients undergoing PMX-DHP. Sixty patients with septic shock (40 survivors and 20 non-survivors). We analyzed HMGB-1 and IL-6 levels before and after PMX-DHP and defined organ failure as two or more SOFA points. There was a significant positive correlation between SOFA score and HMGB-1 level (P<0.05). The HMGB-1 level before PMX-DHP significantly increased as the number of organ failures increased (P<0.01: comparing 2 versus 5 organ failures). IL-6 levels decreased after PMX-DHP (P<0.05 compared with before PMX-DHP), but HMGB-1 levels remained unchanged. HMGB-1 levels of survivors with organ failure in liver decreased after PMX-DHP, but those of non-survivors significantly increased 24h after PMX-DHP compared with before PMX-DHP (P<0.01). In non-survivors with organ failure in liver, HMGB-1 levels were significantly higher than among survivors 24h after PMX-DHP (P<0.01). Our results indicate that HMGB-1 is a useful prognostic biomarker in sepsis-induced organ failure in patients undergoing PMX-DHP.

Efficacy and safety of a phospholipid emulsion (GR270773) in Gram-negative severe sepsis: Results of a phase II multicenter, randomized, placebo-controlled, dose-finding clinical trial

To assess the survival benefit and safety profile of low-dose (850 mg/kg) and high-dose (1350 mg/kg) phospholipid emulsion vs. placebo administered as a continuous 3-day infusion in patients with confirmed or suspected Gram-negative severe sepsis. Preclinical and ex vivo studies show that lipoproteins bind and neutralize endotoxin, and experimental animal studies demonstrate protection from septic death when lipoproteins are administered. Endotoxin neutralization correlates with the amount of phospholipid in the lipoprotein particles. A three-arm, randomized, blinded, placebo-controlled trial. Conducted at 235 centers worldwide between September 2004 and April 2006. A total of 1379 patients participated in the study, 598 patients received low-dose phospholipid emulsion, and 599 patients received placebo. The high-dose phospholipid emulsion arm was stopped, on the recommendation of the Independent Data Monitoring Committee, due to an increase in life-threatening serious adverse events at the fourth interim analysis and included 182 patients. A 28-day all-cause mortality and new-onset organ failure. There was no significant treatment benefit for low- or high-dose phospholipid emulsion vs. placebo for 28-day all-cause mortality, with rates of 25.8% (p = .329), 31.3% (p = .879), and 26.9%, respectively. The rate of new-onset organ failure was not statistically different among groups at 26.3%, 31.3%, 20.4% with low- and high-dose phospholipid emulsion, and placebo, respectively (one-sided p = .992, low vs. placebo; p = .999, high vs. placebo). Of the subjects treated, 45% had microbiologically confirmed Gram-negative infections. Maximal changes in mean hemoglobin levels were reached on day 10 (-1.04 g/dL) and day 5 (-1.36 g/dL) with low- and high-dose phospholipid emulsion, respectively, and on day 14 (-0.82 g/dL) with placebo. Treatment with phospholipid emulsion did not reduce 28-day all-cause mortality, or reduce the onset of new organ failure in patients with suspected or confirmed Gram-negative severe sepsis.

Glomerular filtration is reduced by high tidal volume ventilation in an in vivo healthy rat model

Mechanical ventilation has been associated with organ failure in patients with acute respiratory distress syndrome. The present study examines the effects of tidal volume (V(T)) on renal function using two V T values (8 and 27 mL/kg) in anesthetized, paralyzed and mechanically ventilated male Wistar rats. Animals were randomized into two groups of 6 rats each: V (T)8 (V(T), 8 mL/kg; 61.50 +/- 0.92 breaths/min; positive end-expiratory pressure, 3.0 cmH(2)O; peak airway pressure (PAW), 11.8 +/- 2.0 cmH(2)O), and V T27 (V(T), 27 mL/kg; 33.60 +/- 1.56 breaths/min; positive end-expiratory pressure, none, and PAW, 22.7 +/- 4.0 cmH(2)O). Throughout the experiment, mean PAW remained comparable between the two groups (6.33 +/- 0.21 vs 6.50 +/- 0.22 cmH(2)O). For rats in the V(T)27 group, inulin clearance (mL.min(-1).body weight(-1)) decreased acutely after 60 min of mechanical ventilation and even more significantly after 90 min, compared with baseline values (0.60 +/- 0.05 and 0.45 +/- 0.05 vs 0.95 +/- 0.07; P < 0.001), although there were no differences between groups in mean arterial pressure or gasometric variables. In the V(T)8 group, inulin clearance at 120 min of mechanical ventilation remained unchanged in relation to baseline values (0.72 +/- 0.03 vs 0.80 +/- 0.05). The V(T)8 and V(T)27 groups did not differ in terms of serum thiobarbituric acid reactive substances (3.97 +/- 0.27 vs 4.02 +/- 0.45 nmol/mL) or endothelial nitric oxide synthase expression (94.25 +/- 2.75 vs 96.25 +/- 2.39%). Our results show that glomerular filtration is acutely affected by high tidal volume ventilation but do not provide information about the mechanism.

Using hierarchical dynamic Bayesian networks to investigate dynamics of organ failure in patients in the Intensive Care Unit

In intensive care medicine close monitoring of organ failure status is important for the prognosis of patients and for choices regarding ICU management. Major challenges in analyzing the multitude of data pertaining to the functioning of the organ systems over time are to extract meaningful clinical patterns and to provide predictions for the future course of diseases. With their explicit states and probabilistic state transitions, Markov models seem to fit this purpose well. In complex domains such as intensive care a choice is often made between a simple model that is estimated from the data, or a more complex model in which the parameters are provided by domain experts. Our primary aim is to combine these approaches and develop a set of complex Markov models based on clinical data. In this paper we describe the design choices underlying the models, which enable them to identify temporal patterns, predict outcomes, and test clinical hypotheses. Our models are characterized by the choice of the dynamic hierarchical Bayesian network structure and the use of logistic regression equations in estimating the transition probabilities. We demonstrate the induction, inference, evaluation, and use of these models in practice in a case-study of patients with severe sepsis admitted to four Dutch ICUs.

Progression of Organ Failure in Patients Approaching Brain Stem Death

We performed a retrospective cohort study to document the progression of organ dysfunction in 182 critically ill adult patients who subsequently met criteria for brain stem death (BSD). Patients were admitted to intensive care units (ICUs) of Mayo Medical Center, Rochester, MN, between January 1996 and December 2006. Daily sequential organ failure assessment (SOFA) scores were used to assess the degree of organ dysfunction. Serial SOFA scores were analyzed using analysis of variance (ANOVA). Mean (standard deviation, SD) SOFA score on the first ICU day was 8.9 (3.2). SOFA scores did not significantly change over the course of ICU stay. 67.6% of patients donated one or more organs after BSD was declared. The median time from ICU admission to declaration of BSD was 18.8 h (interquartile range 10.3-45.0), and in those who donated organs, the time from declaration of BSD to organ retrieval was 11.8 h (9.5-17.6). The fact that mean SOFA scores did not change significantly over time, even after BSD occurred, has implications for the timing of retrieval of organs for transplantation.

Methylarginines and mortality in patients with end stage renal disease: A prospective cohort study

Objectives and methods Methylarginines like asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are formed by post-translation methylation of arginine residues in proteins. ADMA inhibits nitric-oxide synthase and predicts clinical outcomes in various diseases including end stage renal disease (ESRD). SDMA competes with l-arginine for cell entry and is associated with organ failure in patients with severe illness. We investigated the inter-relationships between methylargines, l-arginine and other risk factors and tested the prediction power of methylargines for mortality in a prospective cohort study including 288 ESRD patients. Results ADMA and SDMA exceeded the upper limit of the corresponding normal range in almost all cases (98% and 100%, respectively) and were inter-related ( r = 0.30, P < 0.001) but only ADMA was associated with l-arginine. SDMA, was inversely related with haemoglobin ( r = −0.23, P < 0.001) and this association was independent of other risk factors. During the follow-up, 140 patients died. In unadjusted analysis, ADMA was strongly related to death [hazard ratio (HR) (1 μmol/L): 2.07, 95% CI: 1.31–3.26] while plasma SDMA and l-arginine were largely unrelated to survival. In a multiple Cox regression model adjusting for potential confounders, ADMA maintained an independent relationship with death [HR: 1.92, 95% CI: 1.16–3.16]. Conclusions Methylarginines ADMA and SDMA are inter-related. ADMA is associated with l-arginine while SDMA correlates inversely with haemoglobin. ADMA but not SDMA is a death predictor in ESRD. Given the exceedingly high risk for death of this population, establishing whether or not ADMA is causally implicated in the high death risk of ESRD is a research priority.

Comment on “Statin administration did not influence the progression of lung injury or associated organ failures in a cohort of patients with acute lung injury”

Preclinical studies suggest that HMG-CoA reductase inhibitors (statins) may attenuate organ dysfunction. We evaluated whether statins are associated with attenuation of lung injury and prevention of associated organ failure in patients with ALI/ARDS. From a database of patients with ALI/ARDS, we determined the presence and timing of statin administration. Main outcome measures were the development and progression of pulmonary and nonpulmonary organ failures as assessed by changes in PaO2/FiO2 ratio and Sequential Organ Failure Assessment score (SOFA) between days 1 and 7 after the onset of ALI/ARDS. Secondary outcomes included ventilator free days, ICU and hospital mortality, and lengths of ICU and hospital stay. From 178 patients with ALI/ARDS, 45 (25%) received statin therapy. From day 1 to day 7, the statin group showed less improvement in their PaO2/FiO2 ratio (27 vs. 55, P = 0.042). Ventilator free days (median 21 vs. 16 days, P = 0.158), development or progression of organ failures (median ΔSOFA 1 vs. 2, P = 0.275), ICU mortality (20% vs. 23%, P = 0.643), and hospital mortality (27 vs. 37%, P = 0.207) were not significantly different in the statin and non-statin groups. After adjustment for baseline characteristics and propensity for statin administration, there were no differences in ICU or hospital lengths of stay. In this retrospective cohort study, statin use was not associated with improved outcome in patients with ALI/ARDS. We were unable to find evidence for protection against pulmonary or nonpulmonary organ dysfunction.

Company Profile: Tengion

Founded in 2005, Tengion is a clinical-stage organ regeneration company with products in urologic, vascular and renal regeneration based on its proprietary Autologous Organ Regeneration Platform. Tengion uses biocompatible materials and a patient's own (autologous) cells to assemble neo-organs or neo-tissues that are designed to catalyze the body's innate ability to regenerate. Tengion is a fully-integrated organization, with scalable US and European manufacturing and distribution capabilities, experienced research, development, clinical and commercial teams, and significant intellectual property. The company's corporate headquarters and commercial manufacturing facility are in East Norriton, PA, USA, and its research offices, a development laboratory and a pilot manufacturing facility are located in Winston-Salem, NC, USA. Tengion's product candidates may ultimately address the most critical problems facing organ and tissue failure patients, enabling people to lead healthier lives without donor transplants or the side effects of related therapies.

Statin administration did not influence the progression of lung injury or associated organ failures in a cohort of patients with acute lung injury

Preclinical studies suggest that HMG-CoA reductase inhibitors (statins) may attenuate organ dysfunction. We evaluated whether statins are associated with attenuation of lung injury and prevention of associated organ failure in patients with ALI/ARDS. From a database of patients with ALI/ARDS, we determined the presence and timing of statin administration. Main outcome measures were the development and progression of pulmonary and nonpulmonary organ failures as assessed by changes in PaO(2)/FiO(2) ratio and Sequential Organ Failure Assessment score (SOFA) between days 1 and 7 after the onset of ALI/ARDS. Secondary outcomes included ventilator free days, ICU and hospital mortality, and lengths of ICU and hospital stay. From 178 patients with ALI/ARDS, 45 (25%) received statin therapy. From day 1 to day 7, the statin group showed less improvement in their PaO(2)/FiO(2) ratio (27 vs. 55, P = 0.042). Ventilator free days (median 21 vs. 16 days, P = 0.158), development or progression of organ failures (median DeltaSOFA 1 vs. 2, P = 0.275), ICU mortality (20% vs. 23%, P = 0.643), and hospital mortality (27 vs. 37%, P = 0.207) were not significantly different in the statin and non-statin groups. After adjustment for baseline characteristics and propensity for statin administration, there were no differences in ICU or hospital lengths of stay. In this retrospective cohort study, statin use was not associated with improved outcome in patients with ALI/ARDS. We were unable to find evidence for protection against pulmonary or nonpulmonary organ dysfunction.

Acute Renal Failure and Renal Replacement Techniques

Acute renal failure (ARF) is a common event in critical patients usually taking place in a multiorganic failure context. This disorder implies a great clinical challenge. ARF could be defined as a sudden deterioration of the renal function that results in a loss of electrolyte, acid-base and fluid balance control, with subsequent accumulation of nitrogen wastes. Although ARF can appear in a wide range of pa- tients and conditions, its physiopathological bases is shared by most episodes with the hipoperfusion and/or renal ischemia as a triggering of the injury. Shock, and spe- cially septic shock is the main cause of ARF leading to renal replacement techniques. Though in the last twenty years continuous extracorporeal purification techniques have experienced an extraordinary growth, mortality remains high (50-70%). At pre- sent predominance of the continuous renal replacement therapy (CRRT) versus in- termittent hemodialysis (IHD) is based on its better hemodynamic stability, great ver- satility in the hydroelectrolytic handling, favored gaseous exchange and improvement of the ventricular filling pressures, low extracorporeal blood volume, smaller activa- tion of the complement, preferred elimination of fluids from the interstitial space, low rate of complications, control of uremia and the intravascular volume without protein or hydric restriction, possibility of elimination of certain toxics, good tolerance in pa- tients with intracranial hypertension and no need of specialized personnel. CRRT and related procedures are an effective and feasible treatment in patients with acute renal failure, severe cardiovascular instability, multisystem organ failure or politraumatized patients, being a simple and easy choice to implement and monitor. KEY WORDS—Acute renal failure. Continuous renal replacement therapy. Hemo- dialysis. Acute kidney injury. Renal replacement techniques.

Children with chronic organ failure possibly ending in organ transplantation: a survey in an Italian region of 5 000 000 inhabitants

The Italian Piedmont region sponsored in 2005 a population-based registry to assess the epidemiology of childhood chronic organ failure involving kidneys, liver, heart or lungs. Patients in chronic organ failure who were younger than 18 years were selected, and entered the registry when accomplishing the standard failure criteria for each organ. The cases were reported by the general paediatricians of the region and integrated with the data gathered by the Children University Hospital, a tertiary care centre. In Piedmont (647,727 inhabitants < 18 years), a total of 146 children (217 cases per million of paediatric population) were found to be affected by chronic organ failure (mean age 10 years; range 0-17). The organ failure involved kidneys in 68 subjects (48%), liver in 24 (17%), heart in 21 (15%) and lungs in 28 (20%), and was severe in 32 subjects (6 on transplantation waiting list). The most represented disease leading to chronic renal failure was renal hypodysplasia (79%). Chronic liver failure was mostly caused by biliary atresia (30%), autoimmune hepatitis (25%) and Wilson's disease (21%). Dilated cardiomyopathy (62%) and surgically treated congenital cardiopathy were the two leading causes of chronic heart failure. The most represented disease leading to chronic lung failure was cystic fibrosis (89%). This is the first report of the literature focusing on the epidemiology of chronic organ failure in children encompassing a region of 4,000,000 inhabitants. This clinical condition is rare, but medically and socially very demanding not only in childhood but the life along, as most of these patients will need solid organ transplantation decades later.

Resuscitating the Microcirculation in Sepsis: The Central Role of Nitric Oxide, Emerging Concepts for Novel Therapies, and Challenges for Clinical Trials

Microcirculatory dysfunction is a critical element of the pathogenesis of severe sepsis and septic shock. In this Bench-to-Bedside review, we present: 1) the central role of the microcirculation in the pathophysiology of sepsis; 2) new translational research techniques of in vivo video microscopy for assessment of microcirculatory flow in human subjects; 3) clinical investigations that reported associations between microcirculatory dysfunction and outcome in septic patients; 4) the potential role of novel agents to "rescue" the microcirculation in sepsis; 5) current challenges facing this emerging field of clinical investigation; and 6) a framework for the design of future clinical trials aimed to determine the impact of novel agents on microcirculatory flow and organ failure in patients with sepsis. We specifically focus this review on the central role and vital importance of the nitric oxide (NO) molecule in maintaining microcirculatory homeostasis and patency, especially when the microcirculation sustains an insult (as with sepsis). We also present the scientific rationale for clinical trials of exogenous NO administration to treat microcirculatory dysfunction and augment microcirculatory blood flow in early sepsis therapy.

Obesity Correlates With Early Hyperglycemia in Patients With Acute Pancreatitis Who Developed Organ Failure

Early hyperglycemia in acute pancreatitis (AP) is a prognostic sign of severe attack. Obesity, another risk factor for severe AP, is associated with impaired glucose regulation. We hypothesized that obesity is related to early hyperglycemia in patients with severe AP. Forty-four patients with severe AP with organ failure and 127 control patients with AP (33 severe AP and 94 mild AP) but without organ failure were studied. Plasma glucose and patients' height and weight for calculation of body mass index (BMI) were measured at admission. Body mass index was higher in organ failure patients than in controls (median, 27.0 kg/m2 [interquartile range, 24.9-30.4 kg/m2] vs 25.2 kg/m2 [interquartile range, 23.3-27.9 kg/m2; P = 0.007). Glucose level correlated with BMI in organ failure patients (r = 0.463, P = 0.002) but not in controls (r = 0.096, P = 0.28). Eight (18%) organ failure patients and 7 (5.5%) controls had prior type 2 diabetes (P = 0.025). In a logistic regression model, admission glucose level was the only independent predictor of organ failure. Obesity may contribute to early hyperglycemia in patients with AP. Multivariate analysis indicated that obesity is not an independent risk factor for organ failure, but it correlates with early hyperglycemia, which may predispose to systemic complications in AP.

Clinical Relevance of Intra-Abdominal Hypertension in Patients With Severe Acute Pancreatitis

Intra-abdominal hypertension (IAH) contributes to organ failure in patients with abdominal trauma and sepsis and leads to the development of abdominal compartment syndrome (ACS). This study aims to investigate the clinical significance of IAH in patients with severe acute pancreatitis (SAP). Patients admitted to intensive care with SAP underwent daily measurement of intra-abdominal pressure (IAP), recording of the clinical data, and calculation of 4 organ dysfunction scores. Among 18 patients with SAP, 11 (61%) developed IAH (median, 20 mm Hg), whereas 10 (56%) developed ACS. The IAP correlated significantly with the 4 organ dysfunction scores; the scores were significantly higher when IAH existed than when it did not. The admission IAP correlated significantly with the duration of intensive care stay. Patients who developed IAH/ACS had significantly higher organ failure score and greater mortality compared with those who did not. Laparotomy and drainage reduced the IAP by a median of -11 mm Hg and relieved the IAH/ACS in all patients. Intra-abdominal hypertension and ACS are frequent findings in patients with SAP and are associated with deterioration in organ function. Intra-abdominal pressure correlates with the severity of organ failure, and a high admission IAP is associated with prolonged intensive care stay.

Myocardial dysfunction in sepsis studied with the pressure recording analytical method

Myocardial dysfunction is one of the most common organ failures in patients with sepsis characterized by transient biventricular contractility impairment, as well as systolic and diastolic dysfunction. The aim of this study is to value early hemodynamic alterations and myocardial dysfunction in severe sepsis using the pressure recording analytical method (PRAM).

Cytokine Release Following Recruitment Maneuvers

There are reports of rigors and/or clinical deterioration following recruitment maneuvers (RMs), leading us to question whether the use of sustained high-pressure inflation could lead to release of inflammatory mediators. Prospective cohort study of 26 patients with ARDS receiving mechanical ventilation. A single RM was performed during which the mean airway pressure was increased to 40 cm H2O and held constant for a period of 30 s. The concentration of nine cytokines (interleukin [IL]-1, IL-6, IL-8, IL-10, tumor necrosis factor [TNF]-alpha, Fas ligand, vascular endothelial growth factor, TNF receptor 1, TNF receptor 2) was measured longitudinally at three time points: prior to initiation of the RM, 5 min after the RM, and 60 min after the RM. RMs were tolerated well from a hemodynamic perspective. Oxygenation improved as reflected by an increased Pao2/fraction of inspired oxygen (Fio2) ratio from 140+/-49 at baseline to 190+/-78 (mean+/-SD) at 5 min after the RM (p=0.01). At 60 min, the increase in Pao2/Fio2 ratio, to 172+/-76, was no longer significant (p=0.1). There were no important changes in the levels of any of the measured cytokines at 5 min or 60 min following RM as compared with the baseline levels. The results of our study demonstrate that recruitment maneuvers are well tolerated in patients with ARDS. Our data suggest no major hemodynamic or immunologic evidence of deterioration within the first hour of RM. In particular, cytokines, previously related to worsening lung injury and distal organ failure in patients with ARDS, are not elevated by use of an RM. Registered at: www.clinicaltrials.gov as NCT00127491.

Exploring pathways to improve indigenous organ donation

Australia has one of the worst organ donation rates in the western world. The consequence of this is that the waiting list for life-saving transplants is increasing. Australia has a highly successful transplant programme, but a limited number of organs are donated. Unfortunately, Aboriginal people are over-represented in the organ-failure patient group--particularly in end-stage renal disease. Renal transplantation has the potential to improve quantity and quality of life for Aboriginal people with renal failure. Aboriginal people have a right to be given the same opportunities as non-indigenous people to donate their organs at the end of life and improve the transplantation rates among their own people. The most effective way to improve indigenous donation rates will be through improving the knowledge of Aboriginal people about organ donation. There are cultural complexities and end-of-life rituals that make the decision to donate organs difficult, but these issues do not preclude a family from making the decision to donate organs at the end of life. We need to provide Aboriginal communities with appropriately presented information to give them a basis for making an informed decision about organ donation. Equity of access is important. Cultural competence of requestors is important. Consultation, communication and education are the way forward.

Palliative care training to improve outcomes for organ failure patients.

Palliative treatment for people with heart disease or dementia may be hindered by lack of awareness of the proximity of death. Of those who died in hospital, 55 per cent of caregivers felt that symptom control was good but 14 per cent thought pain had not been controlled and 45 per cent reported uncontrolled dyspnoea. A further problem was that, despite being known to the hospital, dying patients were admitted to hospital through the emergency department. Here they had to wait in an unsuitable environment although the need was for comfort and spiritual support. The authors suggest that all patients should be cared for according to the principles of palliative care when organ failure is progressive, and that the formation of a palliative care team for terminal non-cancer patients would improve care.

Glutamine kinetics during intravenous glutamine supplementation in ICU patients on continuous renal replacement therapy

To investigate glutamine kinetics during continuous renal replacement therapy (CRRT) in multiple organ failure (MOF) patients with and without exogenous intravenous glutamine supplementation. In a pragmatic clinical study 12 patients without urine production receiving CRRT were prospectively randomized in a cross-over design to receive glutamine intravenously for 20 h before placebo or placebo before glutamine on two consecutive days. Alanyl-glutamine or placebo (saline) was infused. Plasma glutamine concentration was measured in artery, femoral vein, and filtration fluid. Blood flow across the leg was measured and the efflux of glutamine calculated. The rate of appearance of glutamine was calculated from the plasma decay curve of glutamine concentration on the day of treatment. Glutamine supplementation increased plasma concentrations from 570+/-252 to 831+/-367 micromol l(-1). Glutamine losses into the filtration fluids were similar during treatment and control days: 25+/-13 vs. 24+/-11 mmol 24 h(-1), corresponding to 3.6+/-1.9 and 3.5+/-1.6 g 24 h(-1), respectively. Net glutamine balance across the leg was also similar on treatment and control days: 150+/-138 and 188+/-205 nmol min(-1) 100 ml(-1), respectively. The rate of appearance of glutamine was 54+/-17 g 24 h(-1). The loss of glutamine into the ultrafiltrate during CRRT in MOF patients suggests a greater need for exogenous glutamine than in patients without renal failure. The leg efflux and the filtration losses of glutamine were not affected in response to intravenous glutamine supplementation.

Iron metabolism disturbance as a marker of the severity of pathology in resuscitation patients

Forty-eight patients of resuscitation wards were examined, including 15 patients with purulent peritonitis, 12 patients with acute pancreatitis, 11 patients with thermal skin damages, and 10 patients with severe acetic acid intoxication. An increase in the serum iron, ferritin, and free hemoglobin contents of blood plasma influenced the severity of endotoxicosis. This was expressed in progressive fever, increase in the leukocytic intoxication index and concentrations of low-and middle-molecular-weight substances on erythrocytes and in the blood plasma, intensification of lipid peroxidation, and insufficiency of the antioxidant defense system, which resulted in the development of multiple organ failure in patients with the above-mentioned diseases.