Tomoya Hirose1, Kentaro Shimizu2, Hiroshi Ogura3, Osamu Tasaki4, Toshimitsu Hamasaki5, Shuhei Yamano6, Mitsuo Ohnishi7, Yasuyuki Kuwagata8, Takeshi Shimazu9. 1. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: htomoya1979@hp-emerg.med.osaka-u.ac.jp. 2. Department of Clinical Quality Management, Osaka University Hospital, Osaka, Japan. Electronic address: shimiken@hp-emerg.med.osaka-u.ac.jp. 3. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: ogura@hp-emerg.med.osaka-u.ac.jp. 4. Emergency Medical Center, Nagasaki University Hospital, Nagasaki, Japan. Electronic address: tasaki-o@nagasaki-u.ac.jp. 5. Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: hamasakt@medstat.med.osaka-u.ac.jp. 6. Emergency Medical Center, Nagasaki University Hospital, Nagasaki, Japan. Electronic address: snipeshu@gmail.com. 7. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: mohnishi@hp-emerg.med.osaka-u.ac.jp. 8. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: kuwagata@hp-emerg.med.osaka-u.ac.jp. 9. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: shimazu@hp-emerg.med.osaka-u.ac.jp.
Abstract
BACKGROUND & AIMS: Protein metabolism is important in healing wounds, supporting immune function, and maintaining lean body mass. Determination of adequate requirements of amino acids has not been thoroughly clarified in critically ill patients. The purpose of this study was to evaluate 23 plasma amino acids in patients with sepsis and determine prognostic factors. METHODS: This study was a retrospective study. Plasma aminograms were measured in patients with sepsis. We evaluated minimum and maximum values of each amino acid and evaluated prognostic factors by multivariate logistic regression analysis and classification and regression tree (CART) analysis. RESULTS: The study comprised 77 patients. The median intensive care unit (ICU) stay was 30 days (interquartile range 19.5-55.5 days). Whole mortality rate was 39.0%. Maximum values of glutamine, glutamate, glycine, alanine, methionine, phenylalanine, and histidine and minimum values of glutamate, taurine, serine, isoleucine, leucine, tyrosine, ornithine, tryptophan, and arginine were significantly different between survivors and non-survivors (P < 0.05). Statistical analysis using CART analysis revealed the minimum value of glutamate and maximum value of methionine to be significant prognostic factors for mortality (P < 0.05). CONCLUSION: Plasma aminograms were significantly altered in patients with sepsis. Altered balance of aminograms was significantly associated with mortality in patients with sepsis requiring a long ICU stay.
BACKGROUND & AIMS: Protein metabolism is important in healing wounds, supporting immune function, and maintaining lean body mass. Determination of adequate requirements of amino acids has not been thoroughly clarified in critically illpatients. The purpose of this study was to evaluate 23 plasma amino acids in patients with sepsis and determine prognostic factors. METHODS: This study was a retrospective study. Plasma aminograms were measured in patients with sepsis. We evaluated minimum and maximum values of each amino acid and evaluated prognostic factors by multivariate logistic regression analysis and classification and regression tree (CART) analysis. RESULTS: The study comprised 77 patients. The median intensive care unit (ICU) stay was 30 days (interquartile range 19.5-55.5 days). Whole mortality rate was 39.0%. Maximum values of glutamine, glutamate, glycine, alanine, methionine, phenylalanine, and histidine and minimum values of glutamate, taurine, serine, isoleucine, leucine, tyrosine, ornithine, tryptophan, and arginine were significantly different between survivors and non-survivors (P < 0.05). Statistical analysis using CART analysis revealed the minimum value of glutamate and maximum value of methionine to be significant prognostic factors for mortality (P < 0.05). CONCLUSION: Plasma aminograms were significantly altered in patients with sepsis. Altered balance of aminograms was significantly associated with mortality in patients with sepsis requiring a long ICU stay.
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