Combining Phenylalanine and Leucine Levels Predicts 30-Day Mortality in Critically Ill Patients Better than Traditional Risk Factors with Multicenter Validation
In critically ill patients, risk scores are used; however, they do not provide information for nutritional intervention. This study combined the levels of phenylalanine and leucine amino acids (PLA) to improve 30-day mortality prediction in intensive care unit (ICU) patients and to see whether PLA c...
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| Format: | Article |
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MDPI AG
2023-01-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/15/3/649 |
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| author | Yi-Liang Tsou Chao-Hung Wang Wei-Siang Chen Huang-Ping Wu Min-Hui Liu Hsuan-Ching Lin Jung-Jung Chang Meng-Shu Tsai Tien-Yu Chen Cheng-I Cheng Jih-Kai Yeh I-Chang Hsieh |
| author_facet | Yi-Liang Tsou Chao-Hung Wang Wei-Siang Chen Huang-Ping Wu Min-Hui Liu Hsuan-Ching Lin Jung-Jung Chang Meng-Shu Tsai Tien-Yu Chen Cheng-I Cheng Jih-Kai Yeh I-Chang Hsieh |
| author_sort | Yi-Liang Tsou |
| collection | DOAJ |
| description | In critically ill patients, risk scores are used; however, they do not provide information for nutritional intervention. This study combined the levels of phenylalanine and leucine amino acids (PLA) to improve 30-day mortality prediction in intensive care unit (ICU) patients and to see whether PLA could help interpret the nutritional phases of critical illness. We recruited 676 patients with APACHE II scores ≥ 15 or intubated due to respiratory failure in ICUs, including 537 and 139 patients in the initiation and validation (multicenter) cohorts, respectively. In the initiation cohort, phenylalanine ≥ 88.5 μM (indicating metabolic disturbance) and leucine < 68.9 μM (indicating malnutrition) were associated with higher mortality rate. Based on different levels of phenylalanine and leucine, we developed PLA scores. In different models of multivariable analyses, PLA scores predicted 30-day mortality independent of traditional risk scores (<i>p</i> < 0.001). PLA scores were then classified into low, intermediate, high, and very-high risk categories with observed mortality rates of 9.0%, 23.8%, 45.6%, and 81.8%, respectively. These findings were validated in the multicenter cohort. PLA scores predicted 30-day mortality better than APACHE II and NUTRIC scores and provide a basis for future studies to determine whether PLA-guided nutritional intervention improves the outcomes of patients in ICUs. |
| first_indexed | 2024-03-11T09:30:14Z |
| format | Article |
| id | doaj.art-3cab4e0880f741d8aaee620265454ab7 |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-11T09:30:14Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-3cab4e0880f741d8aaee620265454ab72023-11-16T17:39:56ZengMDPI AGNutrients2072-66432023-01-0115364910.3390/nu15030649Combining Phenylalanine and Leucine Levels Predicts 30-Day Mortality in Critically Ill Patients Better than Traditional Risk Factors with Multicenter ValidationYi-Liang Tsou0Chao-Hung Wang1Wei-Siang Chen2Huang-Ping Wu3Min-Hui Liu4Hsuan-Ching Lin5Jung-Jung Chang6Meng-Shu Tsai7Tien-Yu Chen8Cheng-I Cheng9Jih-Kai Yeh10I-Chang Hsieh11Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, TaiwanHeart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, TaiwanHeart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, TaiwanDivision of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung 20401, TaiwanHeart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, TaiwanHeart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, TaiwanDivision of Cardiovascular Disease, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, TaiwanDivision of Cardiovascular Disease, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, TaiwanDivision of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, TaiwanSchool of Medicine, Chang Gung University, Taoyuan 33302, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou 33305, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou 33305, TaiwanIn critically ill patients, risk scores are used; however, they do not provide information for nutritional intervention. This study combined the levels of phenylalanine and leucine amino acids (PLA) to improve 30-day mortality prediction in intensive care unit (ICU) patients and to see whether PLA could help interpret the nutritional phases of critical illness. We recruited 676 patients with APACHE II scores ≥ 15 or intubated due to respiratory failure in ICUs, including 537 and 139 patients in the initiation and validation (multicenter) cohorts, respectively. In the initiation cohort, phenylalanine ≥ 88.5 μM (indicating metabolic disturbance) and leucine < 68.9 μM (indicating malnutrition) were associated with higher mortality rate. Based on different levels of phenylalanine and leucine, we developed PLA scores. In different models of multivariable analyses, PLA scores predicted 30-day mortality independent of traditional risk scores (<i>p</i> < 0.001). PLA scores were then classified into low, intermediate, high, and very-high risk categories with observed mortality rates of 9.0%, 23.8%, 45.6%, and 81.8%, respectively. These findings were validated in the multicenter cohort. PLA scores predicted 30-day mortality better than APACHE II and NUTRIC scores and provide a basis for future studies to determine whether PLA-guided nutritional intervention improves the outcomes of patients in ICUs.https://www.mdpi.com/2072-6643/15/3/649phenylalanineleucineprognosisintensive carebiomarkers |
| spellingShingle | Yi-Liang Tsou Chao-Hung Wang Wei-Siang Chen Huang-Ping Wu Min-Hui Liu Hsuan-Ching Lin Jung-Jung Chang Meng-Shu Tsai Tien-Yu Chen Cheng-I Cheng Jih-Kai Yeh I-Chang Hsieh Combining Phenylalanine and Leucine Levels Predicts 30-Day Mortality in Critically Ill Patients Better than Traditional Risk Factors with Multicenter Validation Nutrients phenylalanine leucine prognosis intensive care biomarkers |
| title | Combining Phenylalanine and Leucine Levels Predicts 30-Day Mortality in Critically Ill Patients Better than Traditional Risk Factors with Multicenter Validation |
| title_full | Combining Phenylalanine and Leucine Levels Predicts 30-Day Mortality in Critically Ill Patients Better than Traditional Risk Factors with Multicenter Validation |
| title_fullStr | Combining Phenylalanine and Leucine Levels Predicts 30-Day Mortality in Critically Ill Patients Better than Traditional Risk Factors with Multicenter Validation |
| title_full_unstemmed | Combining Phenylalanine and Leucine Levels Predicts 30-Day Mortality in Critically Ill Patients Better than Traditional Risk Factors with Multicenter Validation |
| title_short | Combining Phenylalanine and Leucine Levels Predicts 30-Day Mortality in Critically Ill Patients Better than Traditional Risk Factors with Multicenter Validation |
| title_sort | combining phenylalanine and leucine levels predicts 30 day mortality in critically ill patients better than traditional risk factors with multicenter validation |
| topic | phenylalanine leucine prognosis intensive care biomarkers |
| url | https://www.mdpi.com/2072-6643/15/3/649 |
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