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Citrulline and arginine kinetics and its value as a prognostic factor in pediatric critically ill patients

2015; Elsevier BV; Volume: 83; Issue: 4 Linguagem: Inglês

10.1016/j.anpede.2014.10.004

2341-2879

Javier Blasco‐Alonso, Poveda Yánez, Vanessa Rosa-Camacho, J.M. Camacho Alonso, Raquel Yahyaoui, Raquel Gil-Gómez, G. Milano Manso,

Respiratory Support and Mechanisms

Low concentrations of plasma citrulline and arginine have been reported in children under various pathological conditions. Hypothesis: Plasma citrulline and arginine levels undergo different kinetics during the early days of critical illness in children according to the severity of symptoms and can be correlated with other clinical and laboratory parameters associated with the SIR. A single-center prospective observational study was done in patients aged 7 days to 14 years admitted to PICU. Citrulline and arginine blood levels (blood in dry paper, analysis by mass spectrometry in tandem), acute phase reactants and clinical data were collected on admission, at 12 h, 24 h, 3 and 7 days. Forty-four critically ill patients were included and the control group was formed by 42 healthy children. The citrulline and arginine kinetic analysis showed: (1) citrulline falls significantly (p < 0.05) at 12 h of admission; levels remain low until day 7 and begin progressive increase again; (2) arginine is already lowered at 6 h, although an earlier rise occurs (3rd day); and (3) the decrease of citrulline in the first three days of admission positively correlates with arginine kinetics. Bivariate analysis showed: (1) correlation of elevated citrulline on the 7th day with shorter duration of mechanical ventilation, lower PICU stay and lower occurrence of complications. The levels of citrulline still descended at day 7 are associated with increased CRP/procalcitonin elevation at first 24 h; (2) the greatest decrease of arginine in the first 12 h is associated with a longer PICU stay and greater number of complications and increase of acute phase reactants at 3 days. There are decreased levels of arginine and citrulline in the first days at PICU, with recovery at the 3rd and 7th day respectively, and a relationship between a greater decrease and a worse outcome and between a longer income and a higher serum CRP/procalcitonin. Se ha documentado bajas concentraciones de citrulina y arginina plasmáticas en niños en diversas condiciones patológicas. Hipótesis: La cinética de citrulina y arginina plasmáticas durante la enfermedad crítica pediátrica se correlaciona con parámetros evolutivos clínicos y bioquímicos. Estudio observacional unicéntrico prospectivo en pacientes de 7 días a 14 años ingresados en unidad de cuidados intensivos pediátricos (PICU). Los datos bioquímicos y clínicos fueron recogidos al ingreso, a las 12 h, a las 24 h, al 3° y al 7° día. 44 pacientes críticamente enfermos fueron incluidos y un grupo control de 51 niños sanos. La citrulina desciende de forma significativa (p < 0,05) a las 12 h de ingreso con niveles bajos mantenidos hasta el día 7, comenzando un aumento progresivo después. La arginina ya está descendida a las 6h, aunque tiene una subida más precoz (día 3). La disminución de citrulina al tercer día se correlaciona directamente con la arginina. Hay correlación entre la elevación de la citrulina al séptimo día con menor duración de ventilación mecánica, menor estancia en (PICU) y menos complicaciones. Los niveles de citrulina aún descendidos el día 7 se asocian con un mayor aumento de PCR y procalcitonina en primeras 24h. La disminución de arginina en las primeras 12h se correlaciona inversamente con estancia más larga, mayor número de complicaciones y aumento de reactantes de fase aguda en día 3. Hay disminución de arginina y citrulina en los primeros días de la enfermedad crítica, con recuperación al tercero y séptimo día, respectivamente, y existe una relación entre mayor disminución y peor evolución.