Differential effects of sepsis and trauma on urinary excretion of polyamines

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 9; no. 5; p. 406
• Main Authors: Pöyhönen, M J, Takala, J A, Pitkänen, O, Kari, A, Alakuijala, L A, Eloranta, T O
• Format: Journal Article
• Language: English
• Published: United States 01.09.1993
• Subjects: Adult; Analysis of Variance; Bacteremia - metabolism; Bacteremia - therapy; Bacterial Infections - metabolism; Bacterial Infections - therapy; Candidiasis - metabolism; Candidiasis - therapy; Energy Metabolism - physiology; Female; Fungemia - metabolism; Fungemia - therapy; Humans; Male; Middle Aged; Multiple Trauma - metabolism; Multiple Trauma - therapy; Nitrogen - metabolism; Parenteral Nutrition; Polyamines - urine; Putrescine - urine; Spermidine - urine; Spermine - urine
• ISSN: 0899-9007

Urinary excretion of polyamines increases in patients with trauma and infection. To separate the effect of infection from the general metabolic response to sepsis, we studied 7 patients with sepsis and 13 patients with multiple trauma in the intensive-care unit. Urinary excretion of total and free polyamines, putrescine, spermidine, spermine, and their metabolites N1-acetylspermidine (N1-AcSPD) and N8-acetylspermidine (N8-AcSPD), and energy and nitrogen balance were measured. The patients were randomized to receive either hypocaloric glucose alone or with amino acids for 2 days. The excretion of individual polyamines, except spermine, significantly exceeded normal values in both patient groups; the excretion of total polyamines was 530 and 323% higher than normal in patients with sepsis and trauma, respectively. The excretion of N1-AcSPD and total spermidine was 141 and 74% higher in patients with sepsis than in patients with trauma, respectively (p < 0.05), whereas the excretion of N8-AcSPD was equal in both patient groups. This was also reflected as a significantly increased urinary ratio of N1-AcSPD to N8-AcSPD in septic patients (6.37 +/- 1.61; mean +/- SE) compared with patients after injury (2.69 +/- 0.27, p < 0.01) or a healthy population (1.08 +/- 0.04, p < 0.001). Amino acid infusion had no effect on polyamine excretion. The mean energy balance was -17.0 +/- 1.1 and -19.1 +/- 1.1 kcal.kg-1.day-1, and the mean nitrogen balance was -0.17 +/- 0.03 and -0.15 +/- 0.02 g.kg-1.day-1 in patients with sepsis and trauma, respectively (NS).