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Imbalances in protein metabolism in critical care patient with systemic inflammatory response syndrome at admission in intensive care unit.

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Abstract
Antecedentes: el trauma y las infecciones severas causan cambios metabólicos notables en los pacientes con SRIS como una respuesta adaptativa dirigida a controlar la enfermedad subyacente, la reparación del tejido dañado y para sintetizar sustratos. Si el ataque es intenso y sostenido y el paciente tiene un estado nutricional comprometido puede evolucionar a insuficiencia orgánica múltiple y muerte. Objetivo: evaluación del estado nutricional proteico y la participación de las proteínas y los factores inflamatorios en pacientes críticamente enfermos. Método: estudio analítico observacional multicéntrico en pacientes enfermos críticos en la admisión en la UCI. Resultados y discusión: los pacientes mostraron alteraciones en los parámetros nutricionales clínicos que confirman su situación hipercatabólica, mostrando malnutrición a la admisión en UCI, donde el 42,9% tenían niveles plasmáticos de prealbúmina por debajo de la referencia. Los aminoácidos se encuentran por debajo de los valores de referencia y el 99% de los pacientes presentaron bajos niveles plasmáticos de transferrina. Se observaron diferencias significativas en los niveles de proteína total, ferritina y transferrina ajustados por los niveles de PCR, siendo mayor cuando los pacientes presentaron altos valores de inflamación, en el caso de la ferritina, y lo opuesto para el resto de parámetros. Al estratificar por las puntuaciones APACHE y SOFA de acuerdo a la gravedad baja, media y alta, los resultados mostraron diferencias significativas en creatinina, urea y transferrina, siendo menor cuanto mayor era el grado de severidad para la transferrina. Conclusión: la enfermedad crítica se caracteriza por un alto grado de estrés y la degradación acelerada de proteínas que causan malnutrición, inflamación sistémica y la disfunción de órganos, con una asociación significativa entre albúmina, ferritina y transferrina.
BACKGROUND: trauma and severe infections cause remarkable metabolic changes in patient with SIRS from an adaptive response aimed to control the underlying disease, repairing damaged tissue, and to synthesize substrates. If the attack is intense and sustained and the patient has a compromised nutritional status, can evolve into multiple organ failure and death. OBJECTIVE: assessment of nutritional proteic status and the involvement of proteins and inflammatory factors in critically ill patients. METHOD: multicenter observational analytical study in critical ill patients at the admission in ICU. RESULTS AND DISCUSSION: patients showed disturbances in clinical nutritional parameters which confirm their hypercatabolic situation, showing malnutrition state at admission, where 42.9% had plasma levels below the reference prealbumin. Amino acid profile was situated below the reference values and 99% of patients had low plasma transferrin. Significant differences were observed in total protein, ferritin and transferrin parameters adjusted by CRP levels, being higher when patients presented high inflammation in the case of ferritin and the opposite for the rest of parameters. Adjusting APACHE and SOFA scores according to low, medium and high severity, results showed significant differences in creatinine, urea, and transferrin, being lower at high severity grade for the last one. CONCLUSION: critical illness is characterized by a high degree of stress and accelerated degradation of proteins that cause malnutrition, systemic inflammation and organ dysfunction, with a significant association between albumin, ferritin and transferrin.
Description
MeSH Terms
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Health Surveys::Health Status Indicators::APACHE
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Albumins
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Amino Acids
Medical Subject Headings::Phenomena and Processes::Chemical Phenomena::Biochemical Phenomena::Biochemical Processes
Medical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 1-Ring::Azoles::Imidazoles::Creatinine
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Critical Illness
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Metalloproteins::Iron-Binding Proteins::Ferritins
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Intensive Care Units
Medical Subject Headings::Diseases::Nutritional and Metabolic Diseases::Nutrition Disorders::Malnutrition
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Shock::Multiple Organ Failure
Medical Subject Headings::Phenomena and Processes::Physiological Phenomena::Nutritional Physiological Phenomena::Nutritional Status
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Albumins::Serum Albumin::Prealbumin
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Weights and Measures::Reference Values
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation::Systemic Inflammatory Response Syndrome
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Acute-Phase Proteins::Transferrin
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Urea
Medical Subject Headings::Phenomena and Processes::Biological Phenomena::Biological Processes::Regeneration::Wound Healing
DeCS Terms
CIE Terms
Keywords
Critical patient, Hypercatabolism, Protein status, Amino acids, SIRS., Paciente crítico, Hipercatabolismo, Estatus proteico, Aminoácidos
Citation
Bouharras El Idrissi H, Molina López J, Pérez Moreno I, Florea DI, Lobo Támer G, Herrera-Quintana L, et al.Imbalances in protein metabolism in critical care patient with systemic inflammatory response syndrome at admission in intensive care unit. Nutr Hosp. 2015; 32(6):2848-54