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Byline: Peter H. J. Voort (1), Rik T. Gerritsen (1), Andries J. Bakker (2), E. Christiaan Boerma (1), Michael A. Kuiper (1), Loek Heide (3) Keywords: Adrenal; Cortisol; Critically ill; Cholesterol; Synacthen Abstract: Objective To explore the relationship between cholesterol levels and the adrenal cortisol response to synacthen in critically ill patients. Design Prospective observational study. Patients Critically ill patients with multiple organ dysfunction syndrome (MODS) with possible adrenal dysfunction defined as unexplained hypotension, ongoing inotropic support, unexplained fever, unexplained hyponatraemia or a combination of these symptoms. Measurements HDL-cholesterol levels (HDL), total cholesterol levels (TC), and triglycerides (TG) before administration of synacthen. LDL-cholesterol was calculated using the Friedewald formula. Basal cortisol and response to 250 ug synacthen intravenously was measured. A cortisol rise of 0.25 umol/l in a 30-min or 60-min blood sample after synacthen infusion was defined as a proper adrenal response. Results Patients with a proper response to synacthen showed higher HDL-cholesterol levels than patients without that response (P=0.02). Severity of disease as measured by APACHE II or SOFA was not a confounder. LDL-cholesterol levels were extremely low in both responders and non-responders and were not associated with the absolute rise in cortisol. In linear and logistic regression analysis HDL-cholesterol was the sole predictor of cortisol response. Conclusions Adrenal cortisol response to a 'classic' 250-ug synacthen test relates in critically ill patients to HDL-cholesterol levels. LDL and TC levels did not show such a relation. These findings are in concordance with known biochemical pathways of cortisol production. Author Affiliation: (1) Dept. of Intensive Care, Medical Centre Leeuwarden, P.O. Box 888, 8901 BR, Leeuwarden, The Netherlands (2) Dept. of Clinical Chemistry, Medical Centre Leeuwarden, Leeuwarden, The Netherlands (3) Dept. of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands Article History: Received Date: 15/01/2003 Accepted Date: 10/09/2003 Online Date: 18/10/2003

Background: A low plasma glutamine level at the time of acute admission to the intensive care unit (ICU) is an independent predictor of an unfavourable outcome in critically ill patients. The primary objective of this study was to determine whether there are differences in plasma glutamine levels upon non-elective or elective ICU admission. The secondary objective was to compare glutamine levels over time, and to determine correlations between glutamine levels and the severity of illness and presence of infection in ICU patients. Methods: We performed a single-centre observational study in a closed-format, 22-bed, mixed ICU. Plasma glutamine levels were measured at admission and every morning at 6.00 a.m. during the ICU stay. We aimed to include at least 80 patients per group. The study was approved by the local Medical Ethics Committee. Results: In 88 patients after elective surgery, the median plasma glutamine level at admission was significantly higher compared with that in 90 non-elective patients (0.43 mmol/l [0.33-0.55 mmol/l] versus 0.25 mmol/l [0.09-0.37 mmol/l], P = 0.001). During the ICU stay, plasma glutamine levels remained significantly higher in elective patients than in non-elective patients. There was a significant correlation between the APACHE IV score and glutamine levels (R=0.52, P < 0.001). Moreover, backward linear regression analysis showed that this correlation was independently associated with the APACHE IV score and the presence of infection, but not with the type of admission. Conclusions: Plasma glutamine levels are significantly lower after non-elective admission compared with elective admission to the ICU. A considerable amount of elective and non-elective patients have decreased plasma glutamine levels, but this is not independently associated with the type of admission. In contrast to previous studies, we found that plasma glutamine levels were determined by the severity of illness and the presence of an infection. Trial registration: ClinicalTrials.gov, number NCT02310035. [ABSTRACT FROM AUTHOR]

Presents a study which compared albumin-to-creatinine ratio (ACR) and albumin concentration (ALB) for detection of microalbuminuria. Correlation between AER and ALB; Importance of microalbuminuria screening; Value of creatinine excretion in men and women.

Background: Detection and quantification of monoclonal proteins is hampered when the monoclonal peak coincides with one of the regular bands in serum proteinelectrophoresis. The objective of this study was to evaluate four procedures for serum proteinelectrophoresis with respect to detection and quantification of monoclonal proteins., Methods: For 466 patient samples with a monoclonal protein, three variants of agarose gel electrophoresis (5-band, split-β and high resolution) and one variant of capillary electrophoresis were compared with the results of the routinely used agarose gel electrophoresis followed by immunofixation analysis using specific or pentavalent antisera., Results: In total, 310 patient samples were analyzed by the four methods, consisting of 295 samples with a monoclonal protein, seven with oligoclonal bands and eight without any bands. Suspicion of a monoclonal protein was raised in 295/256/256/232/265 of the samples using the reference/5-band/split-β/high resolution/capillary procedure. In 152/147/135/142/126 of the samples the concentration of monoclonal protein was >1.0 g/L and in 51/33/53/33/67 of the cases, the monoclonal protein was not separated from one of the normal protein zones., Conclusions: In high resolution agarose gel electrophoresis, monoclonal bands of low concentration often remain undetected. In split-β agarose gel electrophoresis as well as capillary electrophoresis monoclonal bands more often were not separated from the regular protein bands.