Glutamine in critically ill patients as a predictor of hospital mortality

Glutamine (Gln) is the most abundant amino acid in the body and the amino acid mostly affected by calabolic diseases. Gut mucosal barrier function depends on adequate Gin supply. During critical illness the uptake of Gin by the liver and lymphoid cells is increased. The demands of Gin have to be met by an increased release of Gin by muscle. Gin depletion is a characteristic feature of critical illness. Aim of this study was to assess the blood concentration of Gin in a cohort of critically ill ICU patients, and to relate Gin status to prognostic clinical scores and outcome. Predicted mortality was calculated using four prognostic scoring systems: the Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology (SAPS) II, Mortality Probability Model (MPM) II at ICU admisssion and at 24 h. Gin was measured within the first week of ICU admission. Gin was significantly lower in the patients who died in the hospital (n=l 1) than in the patients who survived (n=18) (Table). There was a significant correlation between Gin and all clinical scores (R > 0.5). Prediction of Gin was most accurate for MPM 24 (R = 0.63, F = 17, p = 0.0004) (Figure). survivors non-survivors age (years) 70 (62 to 79) 71 (62-90) sepsis (Nr) 11 10 medical / surgical 11/7 10/1 total Gln (μmol/L) 580 (521 to 639) 429 (354 to 504)APACHE II 25 (21 to 30) 32 (25 to 38) predicted mortality (%) APACHE II 46 (29 to 63) 69 (49 to 88) SAPS II 51 (39 to 63) 72 (61 to 84) MPMO 42 (28 to 56) 68 (49 to 88) MPM 24 52 (38 to 65) 71 (59 to 83) values in mean and 95% confidence interval, or in numbers of patients, * significant. This Pilot study shows that glutamine depletion is associated with mortality. Glutamine status was significantly related to all prognostic scores. In this cohort of patients glutamine concentration was an even better predictor of hospital mortality than any of the prognostic scores. (Figure Presented)