A randomized pilot study of parenteral glutamine supplementation in severe sepsis
Purpose: Glutamine depletion can occur in critically ill patients and parenteral glutamine supplementation can have beneficial effects on critically ill patients by preserving gut barrier and improving immune function. We wanted to examine the effect of glutamine supplementation in a cohort of severe sepsis patients admitted to a hospital in South East Asia.
Design: A single center, randomized, doubleblinded, placebo-controlled, pilot study. The primary outcome was 28-day mortality. Secondary outcomes were ICU length of stay (LOS), hospital LOS, duration of mechanical ventilation and occurrence of new infections. Disease severity on admission was assessed by Sequential Organ Failure Assessment (SOFA) score.
Setting: Medical intensive care unit (MICU) of Changi General Hospital, which is a 1000-bedded teaching hospital in Singapore.
Patients and participants: Patients admitted to the MICU for severe sepsis with ≥2-organ dysfunction.
Interventions: In the intervention arm, intravenous glutamine was given for 5 days at a dose of 0.5 g/kg body weight/day. The placebo was normal saline.
Measurements and results: Thirty-nine patients were randomized to receive glutamine (n=19) or placebo (n=20). The glutamine group exhibited milder disease severity than placebo (median SOFA score 8 vs 11, p=0.038). There was no overall difference in 28-day mortality between the glutamine and placebo (42% vs 15%, p=0.06). When adjusted for disease severity, the glutamine arm had 5.6 times higher death rates (95% CI 1.1-30.2, p=0.044). The glutamine group had lower incidence of new infections (0% vs 30%, p=0.02). There was no difference in ICU LOS, hospital LOS and the duration of mechanical ventilation.
Conclusions: Parenteral glutamine may increase mortality risk in ICU patients with severe sepsis while reducing the risk of new infections.