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Parenteral glutamine increases serum heat shock protein 70 in critically ill patients

2005; Springer Science+Business Media; Volume: 31; Issue: 8 Linguagem: Inglês

10.1007/s00134-005-2690-5

1432-1238

Thomas R. Ziegler, Lorraine G. Ogden, Kristen D. Singleton, Menghua Luo, Concepción Fernández‐Estívariz, Daniel Griffith, John R. Galloway, Paul E. Wischmeyer,

Hyperglycemia and glycemic control in critically ill and hospitalized patients

Heat shock protein 70 (HSP-70) is protective against cellular and tissue injury. Increased serum HSP-70 levels are associated with decreased mortality in trauma patients. Glutamine (Gln) administration increases serum and tissue HSP-70 expression in experimental models of sepsis. Gln has been safely administered to critically ill patients and can improve clinical outcomes, but the effect of Gln administration on HSP-70 expression in humans is unknown. We examined whether Gln-supplemented parenteral nutrition (PN) increases serum HSP-70 levels in critically ill patients. Randomized, controlled, double-blind study in surgical intensive care units (SICU) in a university hospital. 29 patients admitted to the SICU and requiring PN for more than 7 days. Patients received either Gln-PN (containing alanyl-glutamine dipeptide; 0.5 g/kg per day; n=15) or standard Gln-free PN (control-PN) that was iso-nitrogenous to Gln-PN (n=14). Serum HSP-70 concentrations were measured at enrollment and at 7 days. Clinical outcome measures were also determined. HSP-70 concentrations were unchanged in control-PN subjects from baseline to day 7. In marked contrast, Gln-PN subjects demonstrated significantly higher (3.7-fold) serum HSP-70 concentrations than control subjects. In Gln-PN patients there was a significant correlation between increases in HSP-70 levels over baseline and decrease in ICU length of stay. Gln-PN significantly increases serum HSP-70 in critically ill patients. The magnitude of HSP-70 enhancement in Gln-treated patients was correlated with improved clinical outcomes. These data indicate the need for larger, randomized trials of the Gln effect on serum and tissue HSP-70 expression in critical illness and relationship to clinical outcomes.