Plasma free carnitine in severe trauma: Influence of the association with traumatic brain injury |
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Institution: | 1. Critical Care Unit, Toulouse University Hospital, Avenue du Pr Jean Poulhès, 31059 Toulouse, France;2. Institut des Maladies Métaboliques et Cardiovasculaires, INSERM U1048, Université Paul Sabatier, Avenue du Pr Jean Poulhès, 31059 Toulouse, France;1. Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, 110016, Liaoning, China;2. State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning, 110016, China;3. State Key Laboratory of Materials Processing and Die & Mould Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China;4. State Key Lab of CAD&CG, Zhejiang University, Hangzhou, Zhejiang, 310013, China;1. Department of Trauma and Orthopaedics, Leeds General Infirmary, United Kingdom;2. Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, United Kingdom;3. University of Huddersfield, Department of Trauma and Orthopaedics, Huddersfield Royal Infirmary, United Kingdom |
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Abstract: | BackgroundMetabolic response to severe trauma requires early nutritional resuscitation. Carnitine is essential for lipolysis, the energy source during this hypercatabolic phase. However l-carnitine is not present in nutritional replacement solutions. Furthermore, free carnitine depletion, defined as carnitine plasma level under 36 μmol/L, was not adequately reported in adult patients with severe trauma. The aim of this study was to assess plasma free carnitine levels and factors of variation in severe trauma.MethodOur observational study concerned 38 trauma patients including 18 with traumatic brain injury (TBI). On the third day after trauma, plasma free carnitine concentration was determined (by enzymatic method) while patients received artificial nutrition.ResultsLow plasmatic free carnitine concentration was evidenced in 95% of the patients with a median value of 18 μmol/L (11–47). Univariate analysis showed that mean arterial pressure, serum urea, CKD-EPI and patients with TBI were significantly associated with plasma free carnitine concentration less than 18 μmol/L. Lower plasma free carnitine concentration was observed in the group of patients with TBI with 17.72 μmol/L (11–36) versus 21.5 μmol/L (11–47) for others patients (p = 0.031). Logistic regression analysis showed that severe trauma with TBI and CKD-EPI above 94 mL/min/1.73 m2 appeared to be independent predictor of lower free carnitine plasmatic concentration (Goodness of fit = 0.87 and AUC = 0.89).ConclusionOur observations support hypotheses that plasma free carnitine concentration is lowered in severe injured patients especially for TBI patients and patients with estimated GFR above 94 mL/min/1.73 m2. |
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Keywords: | Carnitine Severe trauma Nutrition Brain trauma |
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