Screening of key protein and micronutrient metabolism markers in ICU patients with acute abdominal pathology. Article

A.V. Nikolenko1, I.N. Leiderman2, V.V. Nikolenko1

1 Perm State Medical University named by Е.А. Vagner Ministry of Health of the Russian Federation, Perm, Russia

2 National Medical Research Center named by V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russia

For correspondence: Ilya N. Leiderman — MD, PhD, Professor of Anesthesiology and Intensive Care Chair of National Medical Research Center named by V.A. Almazov Ministry of Health of the Russian Federation, St.Petersburg; e-mail: inl230970@gmail.com

For citation: Nikolenko AV, Leiderman IN, Nikolenko VV. Screening of key protein and micronutrient metabolism markers in ICU patients with acute abdominal pathology. Article. Annals of Critical Care. 2019;4:81–87.

DOI: 10.21320/1818-474X-2019-4-81-87


Abstract

Objectives. The purpose of this study is a comparative assessment of the dynamics of key markers of protein and micronutrient metabolism disorders in ICU patients with acute abdominal disease in survivors and non-survivors.

Materials and methods. A continuous screening was carried out for 532 patients hospitalized in surgical ICU. After analyzing 532 registration cards, two comparable groups were formed. Group 1 — survived patients. Group 2 — patients with negative clinical outcome.

Results. Serum albumin and transferrin in both groups were reduced already upon admission. By 7–10 days in non-survivors more significant decrease in total protein, albumin and transferrin was recorded. In survivors, a drop in these markers was also noted, however, their values were significantly higher. From admission both groups showed a decrease in the levels of iron, zinc and copper below normal, however, the survivors had significantly higher (p = 0.001) iron and copper serum concentrations. By 7–10 days in non-survivors, an even more significant decrease in these markers was noted compared with Day 1. Serum albumin levels were moderately correlated on Days 1 and 3 with the concentration of zinc (r = 0.448, p = 0.017 and r = 0.535, p = 0.003) and iron (r = 0.448, p = 0.008 and r = 0.535, p = 0.021), respectively. A strong link between transferrin and serum iron concentration was detected at Day 1 (r = 0.729, p = 0.000) and Day 10 (r = 0.821, p = 0.000), as well as with serum zinc levels (r = 0.713, p = 0.008 and r = 0.735, p = 0.012, respectively).

Conclusion. The relationship between visceral protein pool disorders and iron and zinc metabolism is most clearly detected.

Keywords: malnutrition, acute abdominal surgical pathology, protein deficiency, trace elements

Received: 28.09.2019

Accepted: 05.11.2019


References

  1. Mercadal-Orla G., Lluch-Taltavull J., Campillo-Artero C., Torrent-Quetglas M. Association between nutritional risk based on the NRS-2002 test and hospital morbidity and mortality. Nutr. Hosp. 2012; 27: 1248–1254. DOI: 10.3305/nh.2012.27.4.5791
  2. Edington J., Boorman J., Durrant E.R., et al. Prevalence of malnutrition on admission to four hospitals in England. Clin. Nutr. 2000; 19:.191–195.
  3. Waitzberg D.L., Caiaffa W.T., Correia M.I.T.D. Hospital malnutrition: The Brazilian National Survey (IBRANUTRI): A study of 4000 patients. Nutrition. 2001; 17: 573–580.
  4. Norman K., Pichard C., Lochs H., Pirlich M. Prognostic impact of disease-related malnutrition. Clin. Nutr. 2008; 27: 5–15.
  5. Sorensen J., Kondrup J., Prokopowicz J., et al. EuroOOPS: An international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin. Nutr. 2008; 27; 340–349.
  6. Николенко А.В., Шабунина Д.И., Николенко В.В. Метаболические изменения у пациентов с острой хирургической патологией органов брюшной полости. Сборник статей международной научно-практической конференции. В 4 частях. Инновации, технологии, наука. 2017: 218–221. [Nikolenko A.V., Shabunina D.I., Nikolenko V.V. Metabolicheskie izmeneniya u pacientov s ostroj hirurgicheskoj patologiej organov bryushnoj polosti. Sbornik statej mezhdunarodnoj nauchno-prakticheskoj konferencii. V 4 chastyah. Innovacii, tekhnologii, nauka. 2017: 218–221. (In Russ)]
  7. Stratton R.J., Hackston A., Longmore D., et al. Malnutrition in hospital outpatients and inpatients: Prevalence, concurrent validity and ease of use of the “malnutrition universal screening tool” (“MUST”) for adults. Br. J. Nutr. 2004; 92: 799–808.
  8. Луфт В., Афончиков В., Дмитриев А. и др. Руководство по клиническому питанию [руководство]. СПб.: Арт-Экспресс, 2016.[Luft V.M., Afonchikov V.S., Dmitriev A.V., et al. Rukovodstvo po klinicheskomu pitaniyu [rukovodstvo]. St. Petersburg: Art-Ekspress, 2016. (In Russ)]
  9. Бояринцев В.В., Евсеев М.А. Метаболизм и нутритивная поддержка хирургического пациента. СПб.: Онли-Пресс, 2017. [Boyarincev V.V., Evseev M.A. Metabolizm i nutritivnaya podderzhka hirurgicheskogo pacienta. St. Petersburg: Onli-Press, 2017. (In Russ)]
  10. Rech M., To L., Tovbin A., et al. Heavy metal in the intensive care unit: a review of current literature on trace element supplementation in critically ill patients. Nutr Clin Pract. 2014; 29: 78–89. DOI 10.1177/0884533613515724
  11. Cander B., Dundar Z.D., Gul M., Girisgin S. Prognostic value of serum zinc levels in critically ill patients. J Crit Care. 2011; 26: 42–46. DOI: 10.1016/j.jcrc.2010.06.002
  12. Heyland D.K., Jones N., Cvijanovich N.Z., Wong H. Zinc supplementation in critically ill patients: a key pharmaconutrient? JPEN J Parenter Enteral Nutr. 2008; 32: 509–519. DOI: 10.1177/0148607108322402
  13. Besecker B.Y., Exline M.C., Hollyfield J., et al. A comparison of zinc metabolism, inflammation, and disease severity in critically ill infected and noninfected adults early after intensive care unit admission. Am J Clin Nutr. 2011; 93: 1356–1364. DOI: org/10.3945/ajcn.110.008417
  14. McClave S.A., Taylor B.E., Martindale R.G., et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) JPEN. J Parenter Enteral Nutr. 2016; 40: 159–211. DOI: 10.1177/0148607115621863
  15. Stefanowicz F., Gashut R.A., Talwar D., et al. Assessment of plasma and red cell trace element concentrations, disease severity, and outcome in patients with critical illness. J Crit Care. 2014; 29: 214–218. DOI: 10.1016/j.jcrc.2013.10.012
  16. Singer P., Berger M.M., Van den Berghe G., et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009; 28: 387–400. DOI: 10.1016/j.clnu.2009.04.024
  17. Marx G. Fluid therapy in sepsis with capillary leakage. European Journal of Anaesthesiology. 2003; 20(6): 429–442.
  18. Поляков И.В., Лейдерман И.Н., Золотухин К.Н. Проблема белково-энергетической недостаточности в отделениях реанимации интенсивной терапии хирургического профиля. Вестник интенсивной терапии. 2017; 1; 56–66. [Polyakov I.V., Lejderman I.N., Zolotuhin K.N. Problema belkovo-energeticheskoj nedostatochnosti v otdeleniyah reanimacii intensivnoj terapii hirurgicheskogo profilya. Vestnik intensivnoj terapii. 2017; 1: 56–66. (In Russ)]
  19. Jain S., Gautam V., Naseem S. Acute-phase proteins: As diagnostic tool. J. Pharm. Bioallied Sci. 2011: 1; 118–127.
  20. Kalantar-Zadeh K., Kleiner M., Dunne E., et al. Total iron-binding capacity-estimated transferrin correlates with the nutritional subjective global assessment in haemodialysis patients. Am. J. Kidney Dis. 1998, 31, 263–272.
  21. Lee Y.H., Bang E.-S., Lee J.-H., et al. Serum Concentrations of Trace Elements Zinc, Copper, Selenium, and Manganese in Critically Ill Patients. Biological Trace Element Research. 2019; 188: 316–325. DOI: 10.1007/s12011-018-1429-4
  22. Свиридов С., Федоров С., Алиева Т., Розумейко В. Биомаркеры системного воспаления и уровень микроэлементов Zn++ и Cu++ при оценке тяжести состояния хирургических больных с гнойными ранами мягких тканей. Российский медицинский журнал. 2010; 5: 19–21. [Sviridov S.V., Fedorov S.V., Alieva T.U., Rozumejko V.P. Biomarkery sistemnogo vospaleniya i uroven’ mikroelementov Zn++ i Cu++ pri ocenke tyazhesti sostoyaniya hirurgicheskih bol’nyh s gnojnymi ranami myagkih tkanej. Rossijskij medicinskij zhurnal. 2010; 5: 19–21. (In Russ)]
  23. Свиридов С., Федоров С., Алиева Т. и др. О чем «молчат» микроэлементы. Вестник интенсивной терапии. 2012; 2: 11–17.[Sviridov S.V.,Fedorov S.V. Alieva T.U., et al. O chem “molchat” mikroelementy. Vestnik intensivnoj terapii. 2012; 2: 11–17. (In Russ)]
  24. Berger M.M., Baines M., Raffoul W., et al. Trace element supplementation after major burns modulates antioxidant status and clinical course by way of increased tissue trace element concentrations. Am J Clin Nutr. 2007; 85(5): 1293–1300.