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Effects of L-alanyl L-glutamine dipeptide-supplemented parenteral nutrition on lymphocyte subpopulations and in prevalence of nosocomial infection in critically ill patients

Background

In critically ill patients glutamine (GLN) becomes an essential amino acid. Several studies showed a relationship between GLN depletion and the increased nosocomial infection in ICU patients. There are a kinetics profile of lymphocyte activation from early (CD69) to late (CD25 and HLA-DR) cell surface marker expression that relates directly to the ability to mount an effective immune response to infectious agents. The purpose of the present study is to investigate the effects of glutamine-supplemented parenteral nutrition on lymphocyte subpopulations and the kinetics profile of lymphocyte expression markers of activation, and correlate it with the infectious morbidity in critically ill patients.

Patients and methods

We performed a blind randomised, controlled study of GLN-enriched parenteral nutrition (GLN-PN). Twenty-eight critically ill patients were randomly assigned to two groups of nutrition therapies, as either Dipeptiven® (0.40 g/kg/day) supplemented parenteral nutrition (glutamine group n = 16) or an isocaloric and isonitrogenous standard parenteral nutrition (standard group n = 12). Blood samples were obtained for lymphocyte subpopulations (NK, CD3, CD4, CD8, CD56, CD19, CD25, CD69 and HLA-DR) at the beginning and at the fifth and 10th day after standard TPN. Flow cytometry analysis was performed immediately. Nosocomial infections from entry to discharge from the ICU were determined.

Results

Baseline data (age, sex and severity score – APACHE II) were similar in the standard and glutamine groups. GLN-PN-treated patients had less nosocomial infections (14 vs 25 nosocomial infectious episodes). The CD4/CD8 ratio showed an increase from day 1 to day 5 in the GLN group. Mean lymphocyte expression activation marker CD69 and HLA-DR are slightly increased at day 5 in the standard group, while the later expression lymphocyte activation marker CD25 is increased in the GLN group (Fig. 1). The mortality in the ICU is increased in the standard group (25 vs 12.5%).

Figure 1
figure1

(abstract P364)

Conclusions

We conclude that in critically ill patients GLN-PN can reduce the incidence of infectious complications and mortality. This pilot study showed that the GLN-PN supplement improved not only lymphocyte activation, but also regulatory mechanisms of lymphocyte proliferation, illustrated by increased lymphocyte expression surface marker CD25, compared with CD69 and HLA-DR. This effect can apparently decrease nosocomial infections and mortality in ICU patients.

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Martins, P., Alves, L., Rosa, M.S. et al. Effects of L-alanyl L-glutamine dipeptide-supplemented parenteral nutrition on lymphocyte subpopulations and in prevalence of nosocomial infection in critically ill patients. Crit Care 9, P364 (2005). https://doi.org/10.1186/cc3427

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Keywords

  • Parenteral Nutrition
  • Nosocomial Infection
  • Lymphocyte Activation
  • Standard Group
  • Lymphocyte Subpopulation