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Temporal changes in muscle glutathione in ICU patients

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Abstract

Objective

This study investigated the changes over time in glutathione and its constituent amino acids in skeletal muscle of ICU patients with multiple organ failure.

Design and setting

Prospective and descriptive pilot study in two medium-sized ICUs with ten beds.

Patients

Critically ill patients (n=10) with multiple organ failure and with an expected ICU stay longer than 6 days were included during their initial 3 days after admission to the ICU.

Measurements and results

Muscle biopsy and blood samples were taken on days 0, 3, and 6 after inclusion and total, reduced, and oxidized glutathione and the related amino acids were determined. During the study period both total and reduced glutathione increased and was in the normal range on day 6. The constituent amino acids normalized during the study period as well.

Conclusions

This pilot study demonstrates a recovery of muscle glutathione concentrations in critically ill patients with ongoing multiple organ failure within 1 week. Restoration of muscle glutathione seems to be a biological process of high priority in this group of patients.

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References

  1. Keller GA, Barke R, Harty JT, Humphrey E, Simmons RL (1985) Decreased hepatic glutathione levels in septic shock. Arch Surg 120:941–945

    Article  CAS  Google Scholar 

  2. Leff J, Parsons P, Day C, Moore F, Repine J (1993) Serum antioxidants as predictors of adult respiratory distress syndrome in patients with sepsis. Lancet 341:777–780

    Article  CAS  Google Scholar 

  3. Pacht ER, Timerman AP, Lykens MG, Merola AJ (1991) Deficiency of alveolar fluid glutathione in patients with sepsis and the adult respiratory distress syndrome. Chest 100:1397–1403

    Article  CAS  Google Scholar 

  4. Metnitz GH, Fischer M, Bartens C, Steltzer H, Lang T, Druml W (2000) Impact of acute renal failure on antioxidant status in multiple organ failure. Acta Anaesthesiol Scand 44:236–240

    Article  CAS  Google Scholar 

  5. Taylor DE, Piantadosi CA (1995) Oxidative metabolism in sepsis and sepsis syndrome. J Crit Care 10:122–135

    Article  CAS  Google Scholar 

  6. Beutler E (1989) Nutritional and metabolic aspects of glutathione. Annu Rev Nutr 9:287–302

    Article  CAS  Google Scholar 

  7. Meister A (1991) Glutathione deficiency produced by inhibitors of its synthesis and its reversal: applications in research and therapy. Pharmacol Ther 51:155–194

    Article  CAS  Google Scholar 

  8. Tischler ME, Fagan JM (1982) Relationship of the reduction-oxidation state to protein degradation in skeletal and atrial muscle. Arch Biochem Biophys 217:191–201

    Article  CAS  Google Scholar 

  9. Hammarqvist F, Luo J-L, Andersson K, Wernerman J (1997) Skeletal muscle glutathione is depleted in critically ill patients. Crit Care Med 25:78–84

    Article  CAS  Google Scholar 

  10. Corbucci GG, Gasparetto A, Candiani A, Crimi G, Antonelli M, Bufi M, De Blasi RA, Cooper MB, Gohil K (1985) Shock-induced damage to mitochondrial function and some cellular antioxidant mechanisms in humans. Circ Shock 15:15–26

    CAS  PubMed  Google Scholar 

  11. Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M (2002) Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 360:219–223

    Article  CAS  Google Scholar 

  12. Wilmore DW, Preston R, Muhlbacher F (1983) Injured man: Trauma and sepsis. In: Winters RW, Green HL (eds) Nutritional support of the seriously ill patients. Academic, London, pp 33–52

  13. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  CAS  Google Scholar 

  14. Vincent J-L, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710

    Article  CAS  Google Scholar 

  15. Le Gall JR, Leneshow S, Saulnier F (1993) A New Simplified Acute Physiology Score (SAPS 2) Based on a European/North American multicenter study. JAMA 270:2957–2963

    Article  Google Scholar 

  16. Bergström J (1962) Muscle electrolytes in man. Scand J Clin Lab Invest. 168:11–14

    Google Scholar 

  17. Fläring UB, Rooyackers OE, Hammarqvist F, Wernerman J (2003) Glutamine attenuates post-traumatic glutathione depletion in human muscle. Clin Sci (Colch) 104:275–282

    Google Scholar 

  18. Hammarqvist F, Luo J-L, Andersson K, Wernerman J (1995) Glutathione and amino acid concentrations in ICU-patients. JPEN J Parenter Enteral Nutr 19:19S

    Google Scholar 

  19. Luo J-L, Hammarqvist F, Andersson K, Wernerman J (1996) Skeletal muscle glutathione after surgical trauma. Ann Surg 223:420–427

    Article  CAS  Google Scholar 

  20. Wennström I, Wernerman J, Hammarqvist F (1999) Postoperative effects of growth hormone and insulin-like growth factor-1 on the nitrogen balance and muscle amino acid pattern. Clin Nutr 18 [Suppl 1]:14

  21. Westman B, Hammarqvist F, Johansson G, Luo J-L, Söderlund K, Wernerman J (1999) Effects of ischaemia and reperfusion on glutathione and energy content in skeletal muscle during elective surgery of abdominal aortic aneurysm. Clin Nutr 18 [Suppl 1]:2

  22. Meister A (1988) Glutathione metabolism and its selective modification. J Biol Chem 25:17205–17208

    Article  Google Scholar 

  23. Vesali RF, Klaude M, Rooyackers OE, Tjäder I, Barle H, Wernerman J (2002) Longitudinal pattern of glutamine/glutamate balance across the leg in long-stay intensive care unit patients. Clin Nutr 21:505–514

    Article  CAS  Google Scholar 

  24. Gamrin L, Essén P, Hultman E, Wernerman J (1996) A descriptive study of skeletal muscle metabolism in critically ill patients: free amino acids, energy rich phosphates, protein, nucleic acids, fat, water and electrolytes. Crit Care Med 24:575–583

    Article  CAS  Google Scholar 

  25. Pettilä V, Pettilä M, Sarna S, Voutilainen P, Takkunen O (2002) Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill. Crit Care Med 30:1705–1711

    Article  Google Scholar 

  26. Kvåle R, Flaaten H (2002) Changes in intensive care from 1987 to 1997—has outcome improved? A single centre study. Intensive Care Med 28:1110–1116

    Article  Google Scholar 

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Acknowledgements

This work was supported by the Swedish Medical Research Council (project no. 04210 and 07140), Maud and Birger Gustavsson Foundation, the Stockholm County Council, Public Health and Medical Science, Department of Research Development and Teaching. The authors thank Mrs Liselott Thunblad and Cristina Hebert for their skilled technical assistance. The excellent assistance of Mrs. Marianne Zander and Mrs. Solveig Eriksson is also gratefully acknowledged.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Astrid Lindgren Children’s Hospital, Karolinska Hospital, 17176, Stockholm, Sweden

    U. B. Fläring

  2. Department of Anaesthesia and Intensive Care, Huddinge University Hospital, Sweden

    O. E. Rooyackers & J. Wernerman

  3. Gastrocentrum at the Department of Surgery, Huddinge University Hospital, Sweden

    F. Hammarqvist

  4. Clinical Research Laboratory, St Görans Hospital, Stockholm, Sweden

    F. Hammarqvist

Authors
  1. U. B. Fläring
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  2. O. E. Rooyackers
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  3. J. Wernerman
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  4. F. Hammarqvist
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Corresponding author

Correspondence to U. B. Fläring.

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Fläring, U.B., Rooyackers, O.E., Wernerman, J. et al. Temporal changes in muscle glutathione in ICU patients. Intensive Care Med 29, 2193–2198 (2003). https://doi.org/10.1007/s00134-003-2031-5

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  • DOI: https://doi.org/10.1007/s00134-003-2031-5

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