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Reply: “Comment on Search and Selection of Probiotics that Improve Mucositis Symptoms in Oncologic Patients. A Systematic Review. Nutrients 2019, 11, 2322”
Open AccessArticle

Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
Centre for Statistical Consultation, Stellenbosch University, Cape Town 8000, South Africa
Wits Donald Gordon Medical Centre ICU, Johannesburg 2193, South Africa
Author to whom correspondence should be addressed.
Nutrients 2020, 12(2), 402;
Received: 3 January 2020 / Revised: 23 January 2020 / Accepted: 27 January 2020 / Published: 3 February 2020
(This article belongs to the Section Clinical Nutrition)
Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU) , correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria. Clinical and biochemical data were collected. Plasma glutamine was categorized as low (<420 µmol/L), normal (420–700 µmol/L), or high (>700 µmol/L). Three hundred and thirty patients (median age 46.8 years, 56.4% male) were enrolled (median APACHE II score) 18.0 and SOFA) score 7.0). On admission, 58.5% had low (median 299.5 µmol/L) and 14.2% high (median 898.9 µmol/L) plasma glutamine levels. Patients with a diagnosis of polytrauma and sepsis on ICU admission presented with the lowest, and those with liver failure had the highest glutamine levels. Admission low plasma glutamine was associated with higher APACHE II scores (p = 0.003), SOFA scores (p = 0.003), C-reactive protein (CRP) values (p < 0.001), serum urea (p = 0.008), and serum creatinine (p = 0.023) and lower serum albumin (p < 0.001). Low plasma glutamine was also associated with requiring mechanical ventilation and receiving nutritional support. However, it was not significantly associated with length of stay or mortality. ROC curve analysis revealed a CRP threshold value of 87.9 mg/L to be indicative of low plasma glutamine levels (area under the curve (AUC) 0.7, p < 0.001). Fifty-nine percent of ICU patients had low plasma glutamine on admission, with significant differences found between diagnostic groupings. Markers of infection and disease severity were significant indicators of low plasma glutamine.
Keywords: plasma glutamine; clinical outcome; critically ill adult patients plasma glutamine; clinical outcome; critically ill adult patients
MDPI and ACS Style

Blaauw, R.; Nel, D.G.; Schleicher, G.K. Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome. Nutrients 2020, 12, 402.

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