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High plasma arginine concentrations in critically ill patients suffering from hepatic failure

European Journal of Clinical Nutrition volume 58, pages 587–593 (2004)Cite this article

Abstract

Objective: In physiological conditions, the liver plays an important role in the regulation of plasma arginine concentrations by taking up large amounts of arginine from the hepatic circulation. When hepatic failure is present, arginine metabolism may be disturbed. Therefore, we hypothesized high arginine plasma concentrations in critically ill patients suffering from hepatic failure.

Design: We prospectively collected blood samples from a cross-section of intensive care unit patients.

Setting: Surgical intensive care unit of a Dutch university medical center.

Subjects: A total of 52 critically ill patients with clinical evidence of dysfunction of more than two organs were recruited.

Measurements: Plasma arginine concentrations were determined by HPLC. We identified correlations of arginine concentrations with organ failure scores and laboratory variables by univariate and multiple regression analyses.

Results: High plasma arginine concentrations were found in critically ill patients developing organ failure. Patients who were in the highest quartile of plasma arginine concentrations had significantly lower fibrinogen concentrations, higher lactic acid concentrations, and longer prothrombin time. Stepwise multiple regression analysis showed that concentrations of arginine were independently associated with the presence of hepatic failure (P=0.03) and renal failure (P=0.048). In addition, lactic acid proved to be an independent determinant of plasma arginine concentration (P=0.014).

Conclusions: Critically ill patients who suffer from hepatic failure have elevated plasma arginine concentrations. Additional arginine in the treatment of these patients can be harmful, and therefore should not be used as a standard nutritional regimen until further evaluation.

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Acknowledgements

We thank W. in ‘t Veld for collecting plasma samples of the studied patients.

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Authors and Affiliations

  1. Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands

    R J Nijveldt, M P C Siroen, H A Prins & P A M van Leeuwen

  2. Department of Surgical Intensive Care Unit, Erasmus University Medical Center, Rotterdam, The Netherlands

    B van der Hoven

  3. Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands

    T Teerlink

  4. Intensive Care Unit, VU University Medical Center, Amsterdam, The Netherlands

    A R J Girbes

Authors
  1. R J Nijveldt
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  2. M P C Siroen
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  3. B van der Hoven
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  4. H A Prins
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  5. A R J Girbes
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  6. P A M van Leeuwen
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Contributions

Contributors: RN managed the data and wrote the first drafts. MS contributed in writing and editing of the manuscript. BvdH judged on the suitability for inclusion of the patients and reviewed the manuscript. TT analysed the blood samples and reviewed the manuscript. HP and AG reviewed the manuscript. PvL supervised the project.

Grant/fellowship: RJ Nijveldt, MD, is a recipient of a fellowship from the Council for Medical Research of the Netherlands Organisation for Scientific Research

Corresponding author

Correspondence to P A M van Leeuwen.

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Nijveldt, R., Siroen, M., van der Hoven, B. et al. High plasma arginine concentrations in critically ill patients suffering from hepatic failure. Eur J Clin Nutr 58, 587–593 (2004). https://doi.org/10.1038/sj.ejcn.1601851

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