Does hyperglycemia affect arginine metabolites in critically ill patients? A prospective cohort and in vitro study

BackgroundChanges in the arginine metabolites asymmetric dimethyl-L-arginine (ADMA) and L-homoarginine and acute blood glucose concentrations have been shown to cause endothelial dysfunction and be independently associated with mortality in Intensive Care Unit (ICU) patients. The aim of this study was to investigate whether hyperglycemia potentially modulates these arginine metabolite concentrations to provide a mechanism that may link hyperglycemia and mortality in this patient group.MethodsA clinical and in vitro study were undertaken. Glucose, glycosylated hemoglobin-A1c (HbA1c) and the stress hyperglycemia ratio (SHR) (to quantify absolute, chronic and relative hyperglycemia respectively) were measured in 1155 acutely unwell adult patients admitted to a mixed medical-surgical ICU. SHR was calculated by dividing the admission glucose by the estimated average glucose over the last 3 months, which was derived from HbA1c. ADMA and l-homoarginine were measured in a plasma sample collected at admission to ICU by liquid chromatography tandem mass spectrometry. The activity of dimethylarginine-dimethylaminohydrolase 1 (DDAH1), the main enzyme regulating ADMA concentrations, was assessed at varying glucose concentrations in vitro by quantifying the conversion of ADMA to citrulline in HEK293 cells that overexpress DDAH1.ResultsIn the clinical study, plasma ADMA was not significantly associated with any measure of hyperglycemia. L-homoarginine was positively associated with glucose (beta = 0.067, p = 0.018) and SHR (beta = 0.107, p < 0.001) after correction for glomerular filtration rate. However, as l-homoarginine is a negative predictor of mortality, the direction of these associations are the opposite of those expected if hyperglycemia was affecting mortality via changes in l-homoarginine. In vitro DDAH1 activity was not significantly influenced by glucose concentrations (p = 0.506).ConclusionIn critically ill patients the association between relative hyperglycemia and mortality is not mediated by changes in ADMA or L-homoarginine.Trial registration ANZCTR Trial ID ACTRN12615001164583.

Automated summary

This study aimed to investigate whether hyperglycemia may link to mortality in ICU patients through changes in arginine metabolite concentrations. The results showed that plasma ADMA was not significantly associated with any measure of hyperglycemia. L-homoarginine was positively associated with glucose and SHR, but as it is a negative predictor of mortality, the direction of these associations are the opposite of those expected. In vitro DDAH1 activity was not significantly influenced by glucose concentrations. Therefore, the association between relative hyperglycemia and mortality in critically ill patients is not mediated by changes in ADMA or L-homoarginine.