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[Effect of glutamine depletion on immunity and other organ function in critically ill patients]
Xin-ying Wang1, Wei-qin Li, Ning Li
1Research Institute of General Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, Jiangsu, China. wxinying@263.net
Objective:
To evaluate the effect of glutamine depletion on immunity and other organ function in critically ill patients.
Methods:
Ten healthy individuals served as control group. Forty seriously ill patients [acute pathological and chronic health evaluation II (APACHE II) score> or =8] admitted to the surgical critical care unit (SICU) were enrolled for study. Blood samples were collected at 6:00 am 48 hours after the admission for the determination of plasma glutamine (Gln), and parameters pertaining to immunity and organ functions.
Results:
The Gln levels in critically ill patients were significantly lower than that of control and negatively correlated with APACHE II score (r=-0.572, P<0.05). The CD4/CD8 ratio was positively correlated with the Gln level (r=0.704, P<0.05), while the monocyte HLA-DR expression lowered as compared to control. In patients with normal glutamine level, the incidence of abnormal total bilirubin >19 micromol/L, serum creatinine >110 micromol/L, and oxygenation index <300 mm Hg (1 mm Hg=0.133 kPa) was lower compared with those with low glutamine level (all P<0.05). In non-survivors Gln was significantly reduced to (333.2+/-95.1) micromol/L and it was significantly lower as compared to that of survivors (466.1+/-125.2) micromol/L (P<0.05).
Conclusion:
In critically ill surgical patients glutamine depletion is evident, and the reduction in plasma Gln is related to immunosuppression and organ dysfunction.
