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Gamarra Y, Santiago FC, Molina-López J, Castaño J, Herrera-Quintana L, Domínguez Á, Planells E. Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock. Crit Care 2019; 23:162. [PMID: 31064391 PMCID: PMC6505226 DOI: 10.1186/s13054-019-2450-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/17/2019] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to evaluate oxidative stress from glutathione depletion in critically ill patients with a septic shock through the abnormal presence of pyroglutamic acid (PyroGlu) in the urine (indirectly) and through its serum level (directly). METHODS This was a prospective analytical study of 28 critically ill patients with a septic shock who were monitored from admission (initial) to 3 days of stay (final) in the intensive care unit (ICU). Data collected included PyroGlu and glutamic acid (Glu) using liquid chromatography/mass spectrometry, and glutathione peroxidase (GPX) activity with a colorimetric assay. The differences in Glu, PyroGlu, and GPX activity between the septic shock group and healthy control group serving as reference values were evaluated using the Mann-Whitney test. The correlations between Glu, PyroGlu, and GPX activity and clinical outcomes were determined using Spearman's correlation coefficient. RESULTS In patients with septic shock, serum and urine PyroGlu levels were higher, erythrocyte GPX activity/gr Hb was lower, and urine Glu levels were lower compared to healthy control reference values, for both initial and final values. Initial serum Glu levels were also lower. Serum PyroGlu levels had a correlation with both initial and final serum Glu levels; levels also correlated in the urine. Initial serum Glu correlated with the days of mechanical ventilation (P = 0.016) and the days of ICU stay (P = 0.05). Urine Glu/mg creatinine correlated with APACHE II (P = 0.030). This positive correlation observed for serum Glu was not observed for PyroGlu. CONCLUSIONS The current study found that septic patients have higher levels of PyroGlu, lower levels of Glu, and lower erythrocyte GPX activity, suggesting that these biomarkers could be used as an indicator of glutathione depletion. In addition, Glu is related to severity parameters. This study can guide future studies on the importance of monitoring the levels of pyroglutamic acidosis in critical patients with septic shock in order to preserve the oxidative status and its evolution during the stay in the ICU.
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Affiliation(s)
- Yenifer Gamarra
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Health Campus, Adv. del Conocimiento S/N, 18071, Granada, Spain. .,Clinical Analysis Unit, San Cecilio Hospital, 18016, Granada, Spain.
| | - Felipe C Santiago
- Intensive Care Unit, Virgen de las Nieves Hospital, 18014, Granada, Spain
| | - Jorge Molina-López
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Health Campus, Adv. del Conocimiento S/N, 18071, Granada, Spain
| | - José Castaño
- Intensive Care Unit, Virgen de las Nieves Hospital, 18014, Granada, Spain
| | - Lourdes Herrera-Quintana
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Health Campus, Adv. del Conocimiento S/N, 18071, Granada, Spain
| | - Álvaro Domínguez
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Health Campus, Adv. del Conocimiento S/N, 18071, Granada, Spain
| | - Elena Planells
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Health Campus, Adv. del Conocimiento S/N, 18071, Granada, Spain.
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Planells E, Florea D, Molina-López J, Herrera-Quintana L, Domínguez Á, Gamarra Y, Quintero B, Pérez de la Cruz A, Rodriguez-Elvira M. Zinc transporters in blood as useful indicators of severity of systemic inflammation and outcome for critically ill patients. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Godoy P, Caylà JA, Carmona G, Camps N, Álvarez J, Alsedà M, Minguell S, Rodés A, Altet N, Pina JM, Barrabeig I, Orcau Á, Parron I, March J, Follia N, Sabater M, Domínguez Á. Smoking in tuberculosis patients increases the risk of infection in their contacts. Int J Tuberc Lung Dis 2013; 17:771-6. [PMID: 23676160 DOI: 10.5588/ijtld.12.0696] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the risk of latent tuberculous infection (LTBI) among contacts of smokers with tuberculosis (TB). METHODS A study was conducted to determine the prevalence of LTBI among contacts of TB cases aged >14 years in Catalonia, Spain. A survey was carried out for each TB case and their contacts. LTBI was diagnosed using the tuberculin skin test (≥5 mm). The risk of LTBI associated with smoking was determined by multi-variate logistic regression analysis, with adjusted odds ratio (aOR) and their 95% confidence intervals (CI). RESULTS The smoking prevalence among TB cases was 40.7% (439/1079). The prevalence of LTBI among their contacts was 29.7% (2281/7673). It was higher among contacts of smoking index cases (35.3%) than among those of non-smokers (25.7%). Smoking was independently associated with an increased risk of LTBI among contacts (aOR 1.5, 95%CI 1.3-1.7), and was estimated to be responsible for 12.8% of infections. CONCLUSIONS Index case smoking increases the risk of LTBI and should be systematically investigated. A reduction in smoking could lower the risk of infection substantially.
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Affiliation(s)
- P Godoy
- Department of Health, Generalitat de Catalunya (Autonomous Government of Catalonia), Barcelona, Spain.
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