Assessment of asymmetrical dimethylarginine metabolism in patients with critical illness

Ghashut, R. A., Blackwell, S., Ryan, S., Willox, L., McMillan, D. C. , Kinsella, J. and Talwar, D. (2017) Assessment of asymmetrical dimethylarginine metabolism in patients with critical illness. European Journal of Clinical Investigation, 47(4), pp. 279-288. (doi:10.1111/eci.12710) (PMID:27930821)

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Background Critically ill patients experience metabolic disorders including hypercatabolic state and hyperglycaemia and these are associated with poor outcome. Hyperglycaemia and asymmetric dimethylarginine (ADMA) are reported to have significant influences on endothelial dysfunction. The aim of the present study was to examine the relationship between plasma asymmetric dimethylarginine (ADMA) and related arginine metabolism in patients with critical illness. Materials and Methods Two venous blood samples (EDTA) (104 patients), on admission and follow up sample in the last day in ICU (died or discharge sample median 7, IQR 6-8, range 5-15). Plasma ADMA, arginine, homoarginine and symmetrical dimethylarginine (SDMA) were measured by high-performance liquid chromatography (HPLC). Result ADMA (p<0.01) and SDMA (p<0.05) were elevated and homoarginine was decreased (p<0.05) in non-survivors and were directly associated with predicted mortality rate (p<0.05 and p<0.001), SOFA (p<0.05, p<0.001), ICU stay (p<0.05, p<0.001) and mortality (p<0.01, p<0.05). ADMA was directly associated with SDMA (p<0.001), albumin (p<0.05), ICU stay and mortality (p<0.01). SDMA was directly associated with creatinine (p<0.001) and APACHE II score (p<0.001). In the follow up measurements there was a significant decrease in SOFA score (p<0.01), homoarginine (p<0.01), ALT (p<0.01), Lab-Glucose (p<0.01), and albumin (p<0.01). In contrast, there was an increase in arginine ((p<0.01), ADMA (p<0.01), ADMA:SDMA ratio (p<0.01), and the norepinephrine administration (p<0.01). Conclusion In the present longitudinal study ADMA metabolism was altered in patients with critical illness and was associated with disease severity and mortality.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Kinsella, Professor John and McMillan, Professor Donald and Ghashut, Mrs Rawia Ghashut
Authors: Ghashut, R. A., Blackwell, S., Ryan, S., Willox, L., McMillan, D. C., Kinsella, J., and Talwar, D.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Journal of Clinical Investigation
ISSN (Online):1365-2362
Published Online:08 December 2016
Copyright Holders:Copyright © 2016 Stichting European Society for Clinical Investigation Journal Foundation
First Published:First published in European Journal of Clinical Investigation 47(4):279-288
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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