Abstract
Objective. To investigate the immunomodulatory effect of glutamine (Gln)-enriched nutritional support in elderly patients with severe sepsis in an intensive care unit (ICU). Material and methods. A total of 110 elderly patients [acute physiology and chronic health evaluation (APACHE)-II score ≥16 but ≤28 and D-related human leukocyte antigen (HLA-DR) expression ≤50%] with severe sepsis were included in a prospective, randomized, controlled clinical study. The patients were divided into two groups: the control group (n=55) received standard isonitrogenous, isocaloric nutritional support treatment; the Gln group (n=55) received the standard nutritional support treatment as well as an i.v. injection of Gln (10 g/day). Before treatment and at Days 7 and 14 after treatment, blood samples were collected for analysis of serum proteins [pro-albumin, C-reactive protein (CRP)] and total lymphocytes, T-cell subsets and HLA-DR expression were determined. Changes in the APACHE-II and multiple organ dysfunction syndrome (MODS) scores, the length of stay in the ICU, the duration of mechanical ventilation and the 28-day survival rate were recorded. Results. Compared with the control group, the serum level of CRP was much lower in the Gln group (25.8±4.9 vs 15.6±4.2 mg/dl; p=0.001). The total lymphocyte count (1.91±0.33 vs 1.35±0.25×109/l; p=0.001) and the percentage of CD14+ monocytes expressing HLA-DR were significantly higher in the Gln group than the control group at Day 14 (55.3%±6.3% vs 37.3%±4.7%; p=0.001). There were significant decreases in the APACHE-II (10.35±4.35 vs 17.75±4.46; p=0.001) and MODS (5.46±2.17 vs 8.55±2.76; p=0.03) scores in the Gln group. There were no significant differences between the two groups regarding the length of stay in the ICU, the duration of mechanical ventilation and the 28-day survival rate. Conclusions. Gln-enriched nutritional support can increase HLA-DR expression and downregulate the inflammatory response in elderly patients with severe sepsis.