Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Perspective
  • Published:

Alterations in metabolic patterns in critically ill patients—is there need of action?

European Journal of Clinical Nutrition volume 71, pages 431–433 (2017)Cite this article

Subjects

Critical illness covers a wide variety of pathophysiological processes taking place in a severely ill or injured individual, leading to a diversity of functional defects, cellular dysfunctions and organ impairments. Especially, inflammatory response syndrome (SIRS), sepsis and septic shock are common conditions in an intensive care setting and are associated with high rates of morbidity, disability or death.

During Infection, an escalation from sepsis to severe sepsis or septic shock is associated with deregulation of host immune responses. Severe sepsis now defined as sepsis (Sepsis-3), leads to organ dysfunction, endothelial permeability, tissue hypoperfusion, cellular dysoxia, cellular metabolism modification and apoptosis. Recently, the Sepsis-3 definition shifted the diagnosis of sepsis from SIRS caused by infection to infection triggered organ failure.1

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 801–810.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Orešič M, Posti JP, Kamstrup-Nielsen MH, Takala RSK, Lingsma HF, Mattila I et al. Human serum metabolites associate with severity and patient outcomes in traumatic brain injury. EBioMedicine 2016; 12: 118–126.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Carré JE, Orban J-C, Re L, Felsmann K, Iffert W, Bauer M et al. Survival in critical illness is associated with early activation of mitochondrial biogenesis. Am J Respir Crit Care Med 2010; 182: 745–751.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Derde S, Vanhorebeek I, Güiza F, Derese I, Gunst J, Fahrenkrog B et al. Early parenteral nutrition evokes a phenotype of autophagy deficiency in liver and skeletal muscle of critically ill rabbits. Endocrinology 2012; 153: 2267–2276.

    Article  CAS  PubMed  Google Scholar 

  5. Briassoulis G, Briassouli E, Tavladaki T, Ilia S, Fitrolaki DM, Spanaki AM . Unpredictable combination of metabolic and feeding patterns in malnourished critically ill children: the malnutrition-energy assessment question. Intensive Care Med 2014; 40: 120–122.

    Article  CAS  PubMed  Google Scholar 

  6. Dungan KM, Braithwaite SS, Preiser J-C . Stress hyperglycaemia. Lancet 2009; 373: 1798–1807.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Briassoulis G . Are early parenteral nutrition and intensive insulin therapy what critically ill children need?*. Pediatr Crit Care Med 2014; 15: 371–372.

    Article  PubMed  Google Scholar 

  8. Cynober LA . Plasma amino acid levels with a note on membrane transport: characteristics, regulation, and metabolic significance. Nutrition 2002; 18: 761–766.

    Article  CAS  PubMed  Google Scholar 

  9. Su L, Li H, Xie A, Liu D, Rao W, Lan L et al. Dynamic changes in amino acid concentration profiles in patients with sepsis. PloS One 2015; 10: e0121933.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tavladaki T, Spanaki AM, Dimitriou H, Kozlov AV, Duvigneau JC, Weidinger A et al. Bioenergetics and metabolic patterns in early onset severe sepsis or trauma. Intensive Care Med Exp 2015; 3: A43.

    Article  PubMed Central  Google Scholar 

  11. Marino LV, Pathan N, Meyer RW, Wright VJ, Habibi P . An in vitro model to consider the effect of 2 mM glutamine and KNK437 on endotoxin-stimulated release of heat shock protein 70 and inflammatory mediators. Nutrition 2015; 32: 375–383.

    Article  PubMed  Google Scholar 

  12. Briassouli E, Tzanoudaki M, Goukos D, Routsi C, Nanas S, Vardas K et al. Glutamine may repress the weak LPS and enhance the strong heat shock induction of monocyte and lymphocyte HSP72 proteins but may not modulate the HSP72 mRNA in patients with sepsis or trauma. Biomed Res Int 2015; 2015: 806042.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Leguina-Ruzzi A . A commentary on the 2015 Canadian Clinical Practice Guidelines in glutamine supplementation to parenteral nutrition. Crit Care 2016; 20: 7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Briassouli E, Briassoulis G . Glutamine randomized studies in early life: the unsolved riddle of experimental and clinical studies. Clin Dev Immunol 2012; 2012: 749189.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Briassoulis G, Venkataraman S, Thompson A . Cytokines and metabolic patterns in pediatric patients with critical illness. Clin Dev Immunol 2010; 2010: 354047.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Garrabou G, Morén C, López S, Tobías E, Cardellach F, Miró O et al. The effects of sepsis on mitochondria. J Infect Dis 2012; 205: 392–400.

    Article  CAS  PubMed  Google Scholar 

  17. Fitrolaki D-M, Dimitriou H, Kalmanti M, Briassoulis G . CD64-Neutrophil expression and stress metabolic patterns in early sepsis and severe traumatic brain injury in children. BMC Pediatr 2013; 13: 31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Koch A, Gressner OA, Sanson E, Tacke F, Trautwein C . Serum resistin levels in critically ill patients are associated with inflammation, organ dysfunction and metabolism and may predict survival of non-septic patients. Crit Care 2009; 13: R95.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Preiser J-C, Ichai C, Orban J-C, Groeneveld ABJ . Metabolic response to the stress of critical illness. Br J Anaesth 2014; 113: 945–954.

    Article  CAS  PubMed  Google Scholar 

  20. Xiao W, Mindrinos MN, Seok J, Cuschieri J, Cuenca AG, Gao H et al. A genomic storm in critically injured humans. J Exp Med 2011; 208: 2581–2590.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Weijs PJM, Cynober L, DeLegge M, Kreymann G, Wernerman J, Wolfe RR . Proteins and amino acids are fundamental to optimal nutrition support in critically ill patients. Crit Care 2014; 18: 591.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kyle UG, Arriaza A, Esposito M, Coss-Bu JA . Is indirect calorimetry a necessity or a luxury in the pediatric intensive care unit? JPEN J Parenter Enteral Nutr 2012; 36: 177–182.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Author contributions

GB and TT had the concept and designed the article. TT, AMS and HD have substantially contributed to the revision and editing of the draft. All authors edited and approved the final version of the manuscript

Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, University Hospital, Medical School, University of Crete, Heraklion, Greece

    T Tavladaki, A M Spanaki & G Briassoulis

  2. Pediatric Hematology – Oncology, Medical School, University of Crete, Heraklion, Greece

    H Dimitriou

Authors
  1. T Tavladaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A M Spanaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H Dimitriou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G Briassoulis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G Briassoulis.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tavladaki, T., Spanaki, A., Dimitriou, H. et al. Alterations in metabolic patterns in critically ill patients—is there need of action?. Eur J Clin Nutr 71, 431–433 (2017). https://doi.org/10.1038/ejcn.2016.278

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2016.278

Search

Advanced search

Quick links