Shie-Shian Huang1, Jui-Ying Lin2, Wei-Siang Chen3, Ming-Hui Liu4, Chi-Wen Cheng4, Mei-Ling Cheng5, Chao-Hung Wang6. 1. Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan. 2. Nutrition Department, Chang Gung Memorial Hospital, Keelung, Taiwan. 3. Chang Gung University College of Medicine, Taoyuan, Taiwan; Intensive Care Unit, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. 4. Chang Gung University College of Medicine, Taoyuan, Taiwan; Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. 5. Metabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department and Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan. 6. Chang Gung University College of Medicine, Taoyuan, Taiwan; Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. Electronic address: bearty@adm.cgmh.org.tw.
Abstract
OBJECTIVE: To investigate the prognostic value of phenylalanine and leucine in patients with severe infection. METHODS: Ninety-three patients with infection who had a quick Sequential Organ Failure Assessment (qSOFA) score ≥2 were enrolled. Plasma phenylalanine, leucine, albumin, C-reactive protein, pre-albumin, and transferrin were measured and the SOFA score at enrollment was calculated after hospitalization. RESULTS: During the 3-month follow-up, 30 (32.3%) patients died. Death was associated with higher SOFA scores, a higher incidence of bacteremia and admission to the intensive care unit, higher C-reactive protein and phenylalanine levels, worse kidney function, and lower pre-albumin and transferrin levels. Patients were categorized into three groups: high-risk type 1 (phenylalanine ≥84μM), high-risk type 2 (phenylalanine <84μM and leucine <93μM), and low-risk (other). Compared to the low-risk type patients, high-risk type 1 and 2 patients had higher mortality rates (hazard ratio 10.1 (95% CI 2.33-43.5) and hazard ratio 5.56 (95% CI 1.22-25.4), respectively). Type 1 patients had higher SOFA scores, a higher incidence of admission to the intensive care unit, and higher C-reactive protein and leucine levels. Type 2 patients had lower albumin and hemoglobin levels. Multivariable analysis showed that both high-risk types were independent predictors of death. CONCLUSIONS: Phenylalanine- and leucine-defined risk classifications provide metabolic information with prognostic value for patients with severe infection.
OBJECTIVE: To investigate the prognostic value of phenylalanine and leucine in patients with severe infection. METHODS: Ninety-three patients with infection who had a quick Sequential Organ Failure Assessment (qSOFA) score ≥2 were enrolled. Plasma phenylalanine, leucine, albumin, C-reactive protein, pre-albumin, and transferrin were measured and the SOFA score at enrollment was calculated after hospitalization. RESULTS: During the 3-month follow-up, 30 (32.3%) patients died. Death was associated with higher SOFA scores, a higher incidence of bacteremia and admission to the intensive care unit, higher C-reactive protein and phenylalanine levels, worse kidney function, and lower pre-albumin and transferrin levels. Patients were categorized into three groups: high-risk type 1 (phenylalanine ≥84μM), high-risk type 2 (phenylalanine <84μM and leucine <93μM), and low-risk (other). Compared to the low-risk type patients, high-risk type 1 and 2 patients had higher mortality rates (hazard ratio 10.1 (95% CI 2.33-43.5) and hazard ratio 5.56 (95% CI 1.22-25.4), respectively). Type 1 patients had higher SOFA scores, a higher incidence of admission to the intensive care unit, and higher C-reactive protein and leucine levels. Type 2 patients had lower albumin and hemoglobin levels. Multivariable analysis showed that both high-risk types were independent predictors of death. CONCLUSIONS:Phenylalanine- and leucine-defined risk classifications provide metabolic information with prognostic value for patients with severe infection.
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