DIFFERENTIAL-EFFECTS OF SEPSIS AND TRAUMA ON URINARY-EXCRETION OF POLYAMINES (VOL 9, PG 206, 1993)

Urinary excretion of polyamines increases in patients with trauma and infection. To separate the effect of infection from the general metabo lic response to sepsis, we studied 7 patients with sepsis and 13 patie nts with multiple trauma in the intensive-care unit. Urinary excretion of total and free polyamines, putrescine, spermidine, spermine, and t heir metabolites N1-acetylspermidine (N1-AcSPD) and N8-acetylspermidin e (N8-AcSPD), and energy and nitrogen balance were measured. The patie nts were randomized to receive either hypocaloric glucose alone or wit h amino acids for 2 days. The excretion of individual polyamines, exce pt spermine, significantly exceeded normal values in both patient grou ps; the excretion of total polyamines was 530 and 323% higher than nor mal 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 w ith patients after injury (2.69 +/- 0.27, p < 0.01) or a healthy popul ation (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 -1 9.1 +/- 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 sepsi s and trauma, respectively (NS). We suggest that the difference in pol yamine excretion between patients with sepsis and those with trauma is due to microbial synthesis of polyamines, which are then converted to and excreted mainly as N1-AcSPD.