Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock Gamarra Morales, Yenifer Santiago, Felipe C. Molina-López, Jorge Castaño, José Herrera Quintana, Lourdes María Domínguez, Álvaro Planells Del Pozo, Elena María Septic shock Pyroglutamic acid Glutathione peroxidase Glutamic acid Critical patient Aim: The aim of this study was to evaluate oxidative stress from glutathione depletion in critically ill patients with a septic shock through the abnormal presence of pyroglutamic acid (PyroGlu) in the urine (indirectly) and through its serum level (directly). Methods: This was a prospective analytical study of 28 critically ill patients with a septic shock who were monitored from admission (initial) to 3 days of stay (final) in the intensive care unit (ICU). Data collected included PyroGlu and glutamic acid (Glu) using liquid chromatography/mass spectrometry, and glutathione peroxidase (GPX) activity with a colorimetric assay. The differences in Glu, PyroGlu, and GPX activity between the septic shock group and healthy control group serving as reference values were evaluated using the Mann–Whitney test. The correlations between Glu, PyroGlu, and GPX activity and clinical outcomes were determined using Spearman’s correlation coefficient. Results: In patients with septic shock, serum and urine PyroGlu levels were higher, erythrocyte GPX activity/gr Hb was lower, and urine Glu levels were lower compared to healthy control reference values, for both initial and final values. Initial serum Glu levels were also lower. Serum PyroGlu levels had a correlation with both initial and final serum Glu levels; levels also correlated in the urine. Initial serum Glu correlated with the days of mechanical ventilation (P = 0.016) and the days of ICU stay (P = 0.05). Urine Glu/mg creatinine correlated with APACHE II (P = 0. 030). This positive correlation observed for serum Glu was not observed for PyroGlu. Conclusions: The current study found that septic patients have higher levels of PyroGlu, lower levels of Glu, and lower erythrocyte GPX activity, suggesting that these biomarkers could be used as an indicator of glutathione depletion. In addition, Glu is related to severity parameters. This study can guide future studies on the importance of monitoring the levels of pyroglutamic acidosis in critical patients with septic shock in order to preserve the oxidative status and its evolution during the stay in the ICU. 2020-05-11T11:59:02Z 2020-05-11T11:59:02Z 2019-05-07 journal article Gamarra, Y., Santiago, F. C., Molina-López, J., Castaño, J., Herrera-Quintana, L., Domínguez, Á., & Planells, E. (2019). Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock. Critical Care, 23(1), 162. http://hdl.handle.net/10481/61942 10.1186/s13054-019-2450-5 eng http://creativecommons.org/licenses/by/3.0/es/ open access Atribución 3.0 España Springer Nature