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Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock

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 analyti...

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Autores principales: Gamarra, Yenifer, Santiago, Felipe C., Molina-López, Jorge, Castaño, José, Herrera-Quintana, Lourdes, Domínguez, Álvaro, Planells, Elena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505226/
https://www.ncbi.nlm.nih.gov/pubmed/31064391
http://dx.doi.org/10.1186/s13054-019-2450-5
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author Gamarra, Yenifer
Santiago, Felipe C.
Molina-López, Jorge
Castaño, José
Herrera-Quintana, Lourdes
Domínguez, Álvaro
Planells, Elena
author_facet Gamarra, Yenifer
Santiago, Felipe C.
Molina-López, Jorge
Castaño, José
Herrera-Quintana, Lourdes
Domínguez, Álvaro
Planells, Elena
author_sort Gamarra, Yenifer
collection PubMed
description 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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spelling pubmed-65052262019-05-10 Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock Gamarra, Yenifer Santiago, Felipe C. Molina-López, Jorge Castaño, José Herrera-Quintana, Lourdes Domínguez, Álvaro Planells, Elena Crit Care Research 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. BioMed Central 2019-05-07 /pmc/articles/PMC6505226/ /pubmed/31064391 http://dx.doi.org/10.1186/s13054-019-2450-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Gamarra, Yenifer
Santiago, Felipe C.
Molina-López, Jorge
Castaño, José
Herrera-Quintana, Lourdes
Domínguez, Álvaro
Planells, Elena
Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock
title Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock
title_full Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock
title_fullStr Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock
title_full_unstemmed Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock
title_short Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock
title_sort pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505226/
https://www.ncbi.nlm.nih.gov/pubmed/31064391
http://dx.doi.org/10.1186/s13054-019-2450-5
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