Abstract：
Arginine, a conditionally essential amino acid, is key component in metabolic pathways including immune regulation and protein synthesis. Depletion of arginine contributes to worse outcomes in severely ill and surgical patient populations. We assessed prognostic implications of arginine levels and its metabolites and ratios in polymorbid medical inpatients at nutritional risk regarding clinical outcomes and treatment response.
Within this secondary analysis of the randomized controlled Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT), we investigated the association of arginine, its metabolites and ratios (i.e., ADMA and SDMA, ratios of arginine/ADMA, arginine/ornithine, and global arginine bioavailability ratio) measured on hospital admission with short-term and long-term mortality by means of regression analysis.
Among the 231 patients with available measurements, low arginine levels ≤90.05 μmol/l (n = 86; 37 %) were associated with higher all-cause mortality at 30 days (primary endpoint, adjusted HR 3.27, 95 % CI 1.86 to 5.75, p < 0.001) and at 5 years (adjusted HR 1.50, 95 % CI 1.07 to 2.12, p = 0.020). Arginine metabolites and ratios were also associated with adverse outcome, but had lower prognostic value. There was, however, no evidence that treatment response was influenced by admission arginine levels.
This secondary analysis focusing on medical inpatients at nutritional risk confirms a strong association of low plasma arginine levels and worse clinical courses. The potential effects of arginine-enriched nutritional supplements should be investigated in this population of patients.
clinicaltrials.gov as NCT02517476 (registered 7 August 2015).
Within this secondary analysis of the randomized controlled Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT), we investigated the association of arginine, its metabolites and ratios (i.e., ADMA and SDMA, ratios of arginine/ADMA, arginine/ornithine, and global arginine bioavailability ratio) measured on hospital admission with short-term and long-term mortality by means of regression analysis.
Among the 231 patients with available measurements, low arginine levels ≤90.05 μmol/l (n = 86; 37 %) were associated with higher all-cause mortality at 30 days (primary endpoint, adjusted HR 3.27, 95 % CI 1.86 to 5.75, p < 0.001) and at 5 years (adjusted HR 1.50, 95 % CI 1.07 to 2.12, p = 0.020). Arginine metabolites and ratios were also associated with adverse outcome, but had lower prognostic value. There was, however, no evidence that treatment response was influenced by admission arginine levels.
This secondary analysis focusing on medical inpatients at nutritional risk confirms a strong association of low plasma arginine levels and worse clinical courses. The potential effects of arginine-enriched nutritional supplements should be investigated in this population of patients.
clinicaltrials.gov as NCT02517476 (registered 7 August 2015).
摘要：
背景：精氨酸，一种有条件的必需氨基酸，是代谢途径的关键组成部分，包括免疫调节和蛋白质合成。精氨酸的消耗会导致重症和手术患者群体的预后恶化。我们评估了精氨酸水平及其代谢物和比率在营养风险的多态医学住院患者中关于临床结果和治疗反应的预后意义。
方法：在早期营养支持对虚弱的随机对照影响的二级分析中，功能成果,和营养不良医疗住院患者恢复试验(EFFORT)，我们调查了精氨酸的关联，其代谢物和比率(即，ADMA和SDMA,精氨酸/ADMA的比例，精氨酸/鸟氨酸，和全球精氨酸生物利用度比率）通过回归分析对住院患者的短期和长期死亡率进行测量。
结果：在231名具有可用测量值的患者中，低精氨酸水平≤90.05μmol/l(n=86;37%)与30天时较高的全因死亡率相关(主要终点,调整后的HR3.27，95%CI1.86至5.75，p<0.001）和5年时（调整后的HR1.50，95%CI1.07至2.12，p=0.020）。精氨酸代谢物和比率也与不良结局相关，但预后价值较低。有,然而,没有证据表明治疗反应受到入院精氨酸水平的影响.
结论：这项针对有营养风险的内科住院患者的二级分析证实了低血浆精氨酸水平与不良临床病程之间的强烈关联。应在该患者人群中研究富含精氨酸的营养补充剂的潜在作用。
背景：clinicaltrials.gov为NCT02517476（2015年8月7日注册）。
方法：在早期营养支持对虚弱的随机对照影响的二级分析中，功能成果,和营养不良医疗住院患者恢复试验(EFFORT)，我们调查了精氨酸的关联，其代谢物和比率(即，ADMA和SDMA,精氨酸/ADMA的比例，精氨酸/鸟氨酸，和全球精氨酸生物利用度比率）通过回归分析对住院患者的短期和长期死亡率进行测量。
结果：在231名具有可用测量值的患者中，低精氨酸水平≤90.05μmol/l(n=86;37%)与30天时较高的全因死亡率相关(主要终点,调整后的HR3.27，95%CI1.86至5.75，p<0.001）和5年时（调整后的HR1.50，95%CI1.07至2.12，p=0.020）。精氨酸代谢物和比率也与不良结局相关，但预后价值较低。有,然而,没有证据表明治疗反应受到入院精氨酸水平的影响.
结论：这项针对有营养风险的内科住院患者的二级分析证实了低血浆精氨酸水平与不良临床病程之间的强烈关联。应在该患者人群中研究富含精氨酸的营养补充剂的潜在作用。
背景：clinicaltrials.gov为NCT02517476（2015年8月7日注册）。
