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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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ORIGINAL ARTICLES  CRITICAL AND INTENSIVE THERAPY


Minerva Anestesiologica 1998 July-August;64(7-8):345-50

language: English

Rapid turn­over pro­teins in crit­i­cally ill ICU ­patients. Neg­a­tive ­acute ­phase pro­teins or nutri­tional indi­ca­tors?

Casati A., Muttini S., Leggieri C., Colombo S., Giorgi E., Torri G.

Uni­ver­sity of ­Milan, IRCCS H San Raffaele, Milan, Depart­ment of Anaesthe­sio­logy and Inten­sive ­Care


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Back­ground. ­Rapid turn­over pro­teins are ­often ­used as meta­bolic indi­ca­tors in ­patients ­receiving nutri­tional ­therapy. How­ever, ­their plas­matic con­cen­tra­tion can be influ­enced by acti­va­tion of ­acute ­phase reac­tion due to ­stress. The aim of ­this pros­pec­tive, obser­va­tional ­study was to eval­uate ­changes of pos­i­tive and neg­a­tive ­acute ­phase pro­teins in mechan­i­cally ven­ti­lated ICU ­patients ­with ­acute ­stress.
­Methods. Plas­matic con­cen­tra­tions of pre­al­bumin (PRA), ­retinol-­binding pro­tein (RBP), c-reac­tive pro­tein (CRP) as ­well as ­resting ­energy expen­di­ture (REE) and ­nitrogen bal­ance ­were meas­ured in ­thirty ICU ­patients ­before ­starting nutri­tional sup­port (Base­line) and ­then ­after 3 and 8 ­days of paren­teral nutri­tion (TPN).
­Results. Plas­matic con­cen­tra­tions of CRP ­were ­high at base­line and did not ­change (p=0.47), ­while RBP and PRA ­were low and pro­gres­sively ­increased ­during the ­study (p=0.0001 and p=0.004). Per­centage ­changes ­from base­line of ­both PRA and RBP ­were sig­nif­i­cantly cor­re­lated ­with ­nitrogen bal­ance (p=0.01 and p=0.009); ­while no sig­nif­i­cant cor­re­la­tion was ­observed ­between ­changes of ­rapid turn­over pro­teins and CRP (p=0.72 and p=0.10).
Con­clu­sions. All the var­i­ables ­involved in the ­study are ­known to be influ­enced by ­both meta­bolic ­state and res­o­lu­tion of inflam­ma­tion. How­ever, the ­observed ­changes of ­rapid turn­over pro­teins sig­nif­i­cantly cor­re­late ­with ­nitrogen bal­ance in the ­face of a per­sis­tent inflam­ma­tion, as doc­u­mented by CRP plas­matic con­cen­tra­tions. ­This sug­gests ­that RBP and PRA mon­i­toring may be ­used as com­ple­ment clin­ical eval­u­a­tion of nutri­tional ­therapy ­also in ICU ­patients ­with ­ongoing inflam­ma­tion.

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