Urinary excretion of
polyamines increases in patients with
trauma and
infection. To separate the effect of
infection from the general metabolic response to
sepsis, we studied 7 patients with
sepsis and 13 patients with
multiple trauma in the intensive-care unit. Urinary excretion of total and free
polyamines,
putrescine,
spermidine,
spermine, and their metabolites N1-acetylspermidine (N1-AcSPD) and
N8-acetylspermidine (N8-AcSPD), and energy and
nitrogen balance were measured. The patients were randomized to receive either hypocaloric
glucose alone or with
amino acids for 2 days. The excretion of individual
polyamines, except
spermine, significantly exceeded normal values in both patient groups; the excretion of total
polyamines was 530 and 323% higher than normal in patients with
sepsis and
trauma, respectively. The excretion of N1-AcSPD and total
spermidine was 141 and 74% higher in patients with
sepsis than in patients with
trauma, respectively (p < 0.05), whereas the excretion of N8-AcSPD was equal in both patient groups. This was also reflected as a significantly increased urinary ratio of N1-AcSPD to N8-AcSPD in septic patients (6.37 +/- 1.61; mean +/- SE) compared with patients after injury (2.69 +/- 0.27, p < 0.01) or a healthy population (1.08 +/- 0.04, p < 0.001).
Amino acid infusion had no effect on
polyamine excretion. The mean energy balance was -17.0 +/- 1.1 and -19.1 +/- 1.1 kcal.kg-1.day-1, and the mean
nitrogen balance was -0.17 +/- 0.03 and -0.15 +/- 0.02 g.kg-1.day-1 in patients with
sepsis and
trauma, respectively (NS).(ABSTRACT TRUNCATED AT 250 WORDS)