Plasma glutamine levels before cardiac surgery are related to post-surgery infections; an observational study

Hanneke Buter, Matty Koopmans, Ramses Kemperman, Lilian Jekel, Christiaan Boerma, Hanneke Buter, Matty Koopmans, Ramses Kemperman, Lilian Jekel, Christiaan Boerma

Abstract

Background: A low plasma glutamine level was found in 34% of patients after elective cardiothoracic surgery. This could be a result of the inflammation caused by surgical stress or the use of extracorporeal circulation (ECC). But it is also possible that plasma glutamine levels were already lowered before surgery and reflect an impaired metabolic state and a higher likelihood to develop complications. In the present study plasma glutamine levels were measured before and after cardiac surgery and we questioned whether there is a relation between plasma glutamine levels and duration of ECC and the occurrence of postoperative infections.

Methods: We performed a single-centre prospective, observational study in a closed-format, 20-bed, mixed ICU in a tertiary teaching hospital. We included consecutive patients after elective cardiac surgery with use of extracorporeal circulation. Blood samples were collected on the day prior to surgery and at admission on the ICU. The study was approved by the local Medical Ethics Committee (Regional Review Committee Patient-related Research, Medical Centre Leeuwarden, nWMO 115, April 28th 2015).

Results: Ninety patients were included. Pre-operative plasma glutamine level was 0.42 ± 0.10 mmol/l and post-operative 0.38 ± 0.09 mmol/l (p < 0.001). There was no relation between duration of extracorporeal circulation or aortic occlusion time and changes in plasma glutamine levels. A logistic regression analysis showed a significant correlation between the presence of a positive culture during the post-operative course and pre-operative plasma glutamine levels (p = 0.04).

Conclusion: Plasma glutamine levels are significantly lower just after cardiac surgery compared to pre-operative levels. We did not find a relation between the decrease in plasma glutamine levels and the duration of extracorporeal circulation or aortic clamp time. There was a correlation between pre-operative plasma glutamine levels and the presence of a positive culture after cardiac surgery.

Trial registration: ClinicalTrials.gov, number NCT02444780 .

Keywords: Cardiac surgery; Plasma glutamine level; Postoperative infection.

References

    1. Oudemans-van Straaten HM, Bosman RJ, Treskes M, van der Spoel HJI, Zandstra DF. Plasma glutamine depletion and patient outcome in acute ICU admissions. Intensive Care Med. 2001;27:84–90. doi: 10.1007/s001340000703.
    1. Rodas PC, Rooyackers O, Hebert C, Norberg A, Wernerman J. Glutamine and glutathione at ICU admission in relation to outcome. Clin Sci. 2012;122:591–597. doi: 10.1042/CS20110520.
    1. Wernerman J. How to understand the results of studies of glutamine supplementation. Crit Care. 2015;19:385. doi: 10.1186/s13054-015-1090-7.
    1. Wilmore DW, Shabert JK. The role of glutamine in immunologic responses. Nutrition. 1998;14:618–626. doi: 10.1016/S0899-9007(98)00009-4.
    1. Oliveira GP, Dias CM, Pelosi P, Rocco PRM. Understanding the mechanisms of glutamine action in critically ill patients. An Acad Bras Cienc. 2010;82:417–430. doi: 10.1590/S0001-37652010000200018.
    1. Wernerman J. Glutamine supplementation to critically ill patients. Crit Care. 2014;18:214–220. doi: 10.1186/cc13781.
    1. Buter H, Bakker AJ, Kingma WP, Koopmans M, Boerma EC. Plasma glutamine levels in patients after non-elective or elective ICU admission; an observational study. BMC A. 2016;16:15.
    1. Laposata M. The New England journal of medicine SI unit conversion guide. Boston Mass: NEJM Books; 1992. pp. 82–83.
    1. Franke A, Lante W, Fackeldey V, Becker HP, Kurig E, Zoller LG, et al. Pro-inflammatory cytokines after different kinds of cardio-thoracic surgical procedures: is what we see what we know? Eur J Cardiothorac Surg. 2005;28:569–575. doi: 10.1016/j.ejcts.2005.07.007.
    1. Engel JM, Pitz S, Muhling J, Menges T, Martens F, Kwapisz M, Hempelmann G. Role of glutamine administration on T-cell derived inflammatory response after cardiopulmonary bypass. Clin Nutrition. 2009;28:15–20. doi: 10.1016/j.clnu.2008.08.007.
    1. Parry-Billing M, Baigrie RJ, Lamont PM, Morris PJ, Newsholme EA. Effect of major and minor surgery on plasma glutamine and cytokine levels. Arch Surg. 1992;127:1237–1240. doi: 10.1001/archsurg.1992.01420100099017.
    1. Dieleman JM, Nierich AP, van der Maaten JM, et al. Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial. JAMA. 2012;308:1761–1767. doi: 10.1001/jama.2012.14144.
    1. Whitlock RP, Devereaux PJ, Teoh KH, et al. Methylprednisolone in patients undergoing cardiopulmonary bypass(SIRS): a randomized, double-blind, placebo-controlled trial. Lancet. 2015;386:1243–1253. doi: 10.1016/S0140-6736(15)00273-1.
    1. Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer. Ann Surg. 2015;261:497–505. doi: 10.1097/SLA.0000000000000854.

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