Levels of Amino Acid Content in Blood Plasma Associated with an Increased Risk of Adverse Outcomes in Critically Ill Patients

Alekseeva E. V.
candidate of medical sciences, anesthesiologist-reanimatologist, Federal State Budgetary Institution “Central Clinical Hospital and Outpatient Department” Department for President Affairs of the Russian Federation, Moscow

Abstract. First metabolomic studies were conducted in patients being in critical condition on admission in the resuscitation department (during the initial 24-72 hours), to determine prognostic significance of the levels of a wide variety of low molecular weight substances in relation to 28-day survival. In this study, we determined levels of 32 amino acids in the blood plasma of 62 patients being in a critical condition (CC) in the first 6 hours on admission to the intensive care unit (ICU) by the method of high performance liquid chromatography - mass spectrometry. In retrospect, we allocated two groups of ICU patients in accordance with 28-day survival rate: Group 1 (n = 25) - survivors, Group 2 (n = 37) - deceased. Aminograms were compared in groups of patients, and analyzed by using classical methods of statistical analysis (software package Statistica 12) and meta-data mining (Data Mining Statistica 12 applications). Results: 1) Initial aminograms of the blood plasma are different in groups of patients who subsequently died and survived within 28-day period. 2) Accounting of aminogram parameters in predicting probable outcomes increase the accuracy of its determination. 3) The most significant predictors of adverse course of the pathological process in patients being in critical condition in amino acid composition of the blood plasma are the following: changes, compared to the reference values of citrulline level/odds ratio (OR) = 15.3; predictive test - 0.89; specificity - 0.88), and decreased levels of glutamic acid (OR = 5.0; predictability - 0.82; specificity - 0.84). Conclusions. More rapid inclusion of patients in the study revealed earlier pathogenetic mechanisms leading to the adverse outcome of the pathological process in patients being in critical condition.

patients in critical condition, metabolites, amino acids, prediction

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