Scandinavian glutamine trial: a pragmatic multi-centre randomised clinical trial of intensive care unit patients
Abstract
Background Low plasma glutamine concentration is an independent prognostic factor for an unfavourable outcome in the intensive care unit (ICU). Intravenous (i.v.) supplementation with glutamine is reported to improve outcome. In a multi-centric, double-blinded, controlled, randomised, pragmatic clinical trial of i.v. glutamine supplementation for ICU patients, we investigated outcomes regarding sequential organ failure assessment (SOFA) scores and mortality. The hypothesis was that the change in the SOFA score would be improved by glutamine supplementation. Methods Patients (n=413) given nutrition by an enteral and/or a parenteral route with the aim of providing full nutrition were included within 72 h after ICU admission. Glutamine was supplemented as i.v. l-alanyl-l-glutamine, 0.283 g glutamine/kg body weight/24 h for the entire ICU stay. Placebo was saline in identical bottles. All included patients were considered as intention-to-treat patients. Patients given supplementation for >3 days were considered as predetermined per protocol (PP) patients. Results There was a lower ICU mortality in the treatment arm as compared with the controls in the PP group, but not at 6 months. For change in the SOFA scores, no differences were seen, 1 (0,3) vs. 2 (0.4), P=0.792, for the glutamine group and the controls, respectively. Conclusion In summary, a reduced ICU mortality was observed during i.v. glutamine supplementation in the PP group. The pragmatic design of the study makes the r…
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In the Scandinavian glutamine trial, the glutamine group had lower ICU mortality, which was not sustained at 6 months.
“and a lower ICU mortality, which was not sustained at 6 months [47].”
From Nutrition in Sepsis: A Bench-to-Bedside Review. (2020) · cites this paper as [47]
In the Scandinavian glutamine trial, intravenous glutamine supplementation in adequately fed ICU patients had no change in organ failure scores.
“The glutamine group had no change in organ failure scores”
From Nutrition in Sepsis: A Bench-to-Bedside Review. (2020) · cites this paper as [47]
Since the 1990s, many studies in critically ill patients using GLN together with EN or PN at nutritional doses have shown benefits in terms of infectious complication reduction, lower mortality, and reduction of hospital costs.
“Since the 1990s, many studies have been conducted in critically ill patients, mostly using GLN together with EN or PN at nutritional doses (0.2 to 0.3 g/kg/d of GLN); these trials have shown benefits in terms of infectious complication reduction, lower mortality (225, 226, 227) and reduction of hospital costs (228).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [225]
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[SIXTH JESUS CULEBRAS' LECTURE: GLUTAMINE AND THE CRITICAL PATIENT: THE END OF AN AGE?].
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Considerations in Organ Failure
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- Authors
- WERNERMAN, J., KIRKETEIG, T., ANDERSSON, B., BERTHELSON, H., ERSSON, A., FRIBERG, H., GUTTORMSEN, A. B., HENDRIKX, S., PETTILÄ, V., ROSSI, P., SJÖBERG, F., WINSÖ, O., & For the Scandinavian Critical Care Trials Group
- Affiliations
- Karolinska University Hospital (SE)
- Sahlgrenska University Hospital (SE)
- Skåne University Hospital (SE)
- University of Bergen (NO)
- Danderyds sjukhus (SE)
- Helsinki University Hospital (FI)
- Linköping University (SE)
- University Hospital of Umeå (SE)
- Corresponding author
- WERNERMAN, J.
- ORCID
- Venue
- Acta Anaesthesiologica Scandinavica
- Publisher
- Wiley
- Published
- 2011-06-09
- Volume
- 55
- Issue
- 7
- Pages
- 812-818
- ISSN
- 0001-5172 (ISSN-L)
- OpenAlex
- W2162649248
- Cited by
- 132
- References
- 15
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 5 · 2021: 6 · 2020: 9 · 2019: 10 · 2018: 6 · 2017: 9 · 2016: 9 · 2015: 23 · 2014: 28 · 2013: 14 · 2012: 8
- FWCI
- 15.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Anaesthesiologica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Umeå Universitet
- Sahlgrenska Universitetssjukhuset
- Göteborgs Universitet
- Skånes universitetssjukhus
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- glutamine supplementation, L-alanyl-L-glutamine, intensive care unit patients, critically ill patients, ICU mortality, SOFA score, organ failure, parenteral nutrition, enteral nutrition, nutritional support
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Critical Care, Denmark, Double-Blind Method, Female, Finland, Glutamine, Humans, Iceland, Injections, Intravenous, Intensive Care Units, Male, Middle Aged, Multiple Organ Failure, Norway, Sweden, Databases, Factual, Treatment Outcome, Hospital Mortality, APACHE, Endpoint Determination, Kaplan-Meier Estimate, Young Adult
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