Dimethylarginines in critically ill patients with severe sepsis or septic shock

Objective:We investigated the trend of asymmetric dimethylarginine (ADMA) and symmetryc dimethyarginine (SDMA) in patients with severe sepsis and septic shock, and the relationship between dymethylarginines, organ failure, sepsis status and intensive care unit (ICU) mortality. Design: A prospective observational study carried out in three general adults Italian ICUs. Patient: Consecutive patients with severe sepsis or septic shock admitted to ICUs between December 2004 and March 2007. Methods: Plasma ADMA and SDMA were determined immediately after enrolment and on the third, sixth and twelfth days. Organ failure score, sepsis status, standard blood parameters and ICU outcome were collected. Resulòts: Twenty-nine consecutive patients were enrolled. ADMA and SDMA were higher in patients than in healthy volunteers. Sixteen patients who suffered from septic shock during ICU stay had a higher avarage value of daily ADMA and SDMA. ADMA was significantly related to arterial pH level, daily Sequential Organ Failure Assessment score and creatinine. Independent variables predicting ICU mortality were Simplified Acute Physiology Score II, mean Sequential Organ Failure Assessment score and SDMA. Conclusions: Dimethylarginines are not only markers of body catabolism may have a high metabolic activity, tightly related to the risk of adverse outcome of sepsis syndrome.