@misc{10481/61942,
year = {2019},
month = {5},
url = {http://hdl.handle.net/10481/61942},
abstract = {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.},
organization = {Financial support for the study was provided by Project FIS PI10/1993 from
the Spanish Carlos III Health Institute and FEDER European Funds.},
publisher = {Springer Nature},
keywords = {Septic shock},
keywords = {Pyroglutamic acid},
keywords = {Glutathione peroxidase},
keywords = {Glutamic acid},
keywords = {Critical patient},
title = {Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock},
doi = {10.1186/s13054-019-2450-5},
author = {Gamarra Morales, Yenifer and Santiago, Felipe C. and Molina-López, Jorge and Castaño, José and Herrera Quintana, Lourdes María and Domínguez, Álvaro and Planells Del Pozo, Elena María},
}