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Whole blood glutathione status and ICU morbidity in critically ill children
U Fläring1,2, L Ekmark1,2, J Wernerman3,4
1Department of Anaesthesia and Intensive Care at Astrid Lindgren Children's Hospital at Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Insights
A high reduced glutathione ratio in critically ill children is linked to longer hospital stays, increased need for mechanical ventilation, and more organ failures. This finding highlights glutathione status as a key indicator of severity in pediatric intensive care.
Area of Science:
- Biochemistry
- Pediatric Critical Care Medicine
- Oxidative Stress Research
Background:
- Reduced glutathione ratio is a mortality predictor in adult ICU patients.
- Whole blood glutathione status in critically ill children is not well understood.
- This study investigates glutathione status in pediatric intensive care unit (PICU) patients.
Purpose of the Study:
- To determine whole blood glutathione status in PICU patients.
- To investigate the relationship between glutathione redox status and patient morbidity.
- To assess the clinical significance of glutathione levels in pediatric critical illness.
Main Methods:
- Prospective cohort study of 146 critically ill children admitted to a tertiary university hospital PICU.
- Inclusion of healthy children (n=60) and adults (n=10) as reference groups.
- Measurement of total and reduced whole blood glutathione concentrations at admission; recording of patient characteristics.
Main Results:
- A higher fraction of reduced glutathione correlated with longer mechanical ventilation duration (P=0.02) and PICU length of stay (P=0.03).
- In patients with prolonged PICU stays (>5 days), reduced glutathione status was more pronounced in those with >2 organ failures compared to 1-2 organ failures (P<0.01, P<0.05).
- A significant positive correlation was observed between the number of organ failures and the glutathione redox status (r=0.45, P<0.001).
Conclusions:
- Elevated reduced glutathione ratio is associated with extended PICU stay.
- High reduced glutathione levels correlate with prolonged mechanical ventilation.
- Increased reduced glutathione is linked to multiple organ failure in critically ill children.
Background:
A high reduced glutathione ratio is associated with high mortality in adult ICU patients. Whole blood glutathione status in critically ill children is less well characterized. In this study, whole blood glutathione status in pediatric intensive care (PICU) patients was determined and the relation between the redox status of whole blood glutathione and morbidity was investigated.
Methods:
A prospective consecutive cohort of critically ill children (n = 146) admitted to the PICU of a tertiary university hospital, and a reference group of healthy children (n = 60) and healthy adults (n = 10) were included in the study. The concentrations of total and reduced whole blood were determined at admission and patient characteristics were recorded.
Results:
A high fraction of reduced glutathione in the glutathione redox status was associated with longer dependency of mechanical ventilation and length of stay in the PICU (P = 0.02 and P = 0.03 respectively). In patients with a prolonged stay in the PICU (> 5 days), a more reduced state of glutathione was seen in patients who had more than two organ failures as compared to patients with one or two failing organs (P < 0.01 and P < 0.05), respectively. A positive correlation was also seen between numbers of organ failures and redox status of glutathione (r = 0.45, P < 0.001).
Conclusion:
A high reduced glutathione ratio was associated with longer PICU stay, duration of mechanical ventilation, and multiple organ failure.
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