[Characteristics of amino acid metabolism in patients with severe sepsis and septic shock].

The development of the multiorgan dysfunction syndrome, directly determining the severity of the septic process, is characterized by not only inverse ratio of the energy and plastic material, but by metabolic changes which are still unclear and cannot yet be explained. Our purpose was to detect some features of amino acid metabolism in patients with grave sepsis and septic shock. The concentrations of plasma free amino acids were measured on days 1, 3, and 5 in 37 patients with grave sepsis and septic shock. The diagnosis of grave sepsis, septic shock, and organ dysfunction was made proceeding from the criteria defined by R. Bone. The study revealed reliably increased (p < 0.05) levels of arginine, proline, alanine, and the arginine-ornithine index reflecting the direction of arginine transformation in patients with septic shock and grave organ dysfunction (for at least 3 systems). This may be explained by active degradation of endogenous proteins of skeletal muscles, which is characteristic of septic hypermetabolism. Strong correlations were revealed between arginine level and the APACHE-II score (r = 0.57), proline and the same score (r = 0.51), mean arterial pressure and the arginine-ornithine index (r = -0.72), APACHE-II score and the arginine-ornithine index (r = 0.79), arterial lactate and the arginine-ornithine index (r = 0.64). Hence, amino acid metabolism apparently mediates the effects of septic cascade mediators on the following cell.