Intensive Care Medicine

, Volume 36, Issue 4, pp 702–706 | Cite as

Plasma citrulline kinetics and prognostic value in critically ill patients

  • Gaël Piton
  • Cyril Manzon
  • Elisabeth Monnet
  • Benoit Cypriani
  • Olivier Barbot
  • Jean-Christophe Navellou
  • Franck Carbonnel
  • Gilles Capellier
Brief Report

Abstract

Purpose

Multiple organ failure is a leading cause of death in critically ill patients and could be secondary to early gut ischemia. Plasma citrulline is a biomarker of enterocyte mass, and critically ill patients may have enterocyte mass reduction. The objectives of this study were to assess plasma citrulline kinetics and its prognostic value in critically ill patients.

Methods

This prospective observational study included adults without small bowel disease and without chronic renal failure consecutively admitted to a single intensive care unit. Prognostic variables as well as plasma citrulline concentrations were studied at admission, 12, 24, 48 h, and the 7th day after admission. Univariate and multivariate analyses including plasma citrulline (0–10, 11–20, and >20 μmol l−1) and other variables were performed.

Results

Sixty-seven patients were included, and the 28-day mortality was 34%. During the 1st day mean plasma citrulline decreased from 18.8 to 13.5 μmol l−1. Low plasma citrulline at 24 h was associated with low plasma glutamine and arginine (p = 0.01 and 0.04), and high plasma CRP concentration, nosocomial infection rate, and 28-day mortality (p = 0.008, 0.03, and 0.02, respectively). In multivariate analysis plasma citrulline ≤10 μmol l−1 at 24 h and SOFA score ≥8 at 24 h were associated with 28-day mortality (odds ratios 8.70 and 15.08).

Conclusions

In critically ill patients, low plasma citrulline at 24 h is an independent factor of mortality and could be a marker of acute intestinal failure.

Keywords

Plasma citrulline Multiple organ failure Shock Prognosis 

Abbreviation

ICU

Intensive Care Unit

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Copyright information

© Copyright jointly hold by Springer and ESICM 2010

Authors and Affiliations

  • Gaël Piton
    • 1
    • 5
  • Cyril Manzon
    • 1
  • Elisabeth Monnet
    • 2
  • Benoit Cypriani
    • 3
  • Olivier Barbot
    • 1
  • Jean-Christophe Navellou
    • 1
  • Franck Carbonnel
    • 4
  • Gilles Capellier
    • 1
  1. 1.Intensive Care UnitBesançon University HospitalBesançonFrance
  2. 2.Department of Public HealthBesançon University HospitalBesançonFrance
  3. 3.Clinical Chemistry UnitBesançon University HospitalBesançonFrance
  4. 4.Gastroenterology and Nutrition UnitBesançon University HospitalBesançonFrance
  5. 5.Service de Réanimation MédicaleHôpital Jean MinjozBesançonFrance

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