Ornithine alpha-ketoglutarate improves wound healing in severe burn patients: A prospective randomized double-blind trial versus isonitrogenous controls
C. Coudray-lucas et al., Ornithine alpha-ketoglutarate improves wound healing in severe burn patients: A prospective randomized double-blind trial versus isonitrogenous controls, CRIT CARE M, 28(6), 2000, pp. 1772-1776
Objective: To compare the effectiveness on wound healing time in severe bur
n patients of ornithine alpha-ketoglutarate supplementation of enteral feed
ing vs, an isonitrogenous control. Previous clinical and experimental studi
es suggest a beneficial effect of enterally administered ornithine alpha-ke
toglutarate supplementation on protein metabolism in burn patients, but few
data deal with clinical outcome,
Design: Prospective double-blind randomized trial.
Setting: Burn treatment center of an army hospital.
Patients: Forty-seven severe burn patients with total burned body surface a
reas of 25% to 95% and presence of full thickness burn who were prescribed
early exclusive enteral nutrition. Either ornithine alpha-ketoglutarate or
isonitrogenous control (soy protein mixture, Protil-1) were administered tw
ice a day as a bolus (2 x 10 g) at 9 am and 9 pm for 3 wks. The patients we
re evaluated for wound healing time (primary end point), antibiotic use, to
lerance, duration of enteral nutrition, and nutritional status.
Interventions: Serial blood samples were collected in each patient for dete
rmination of serum transthyretin and plasma phenylalanine, and urine sampli
ng was performed for determination of 3-methylhistidine excretion at day 4
and day 21 after burn injury.
Measurements and Main Results: Wound healing times in patients receiving or
nithine alpha-ketoglutarate or Protil-1 were 60 +/- 7 and 90 +/- 12 days, r
espectively (p < .05) for similar grafted surfaces. Based on increased seru
m transthyretin concentrations, both groups showed an improvement of nutrit
ional status at day 21 after burn, Taking a cut-off value of 110 unit burn
standard for severity of injury, plasma phenylalanine concentrations, and u
rinary 3-methylhistidine/creatinine ratio were significantly reduced (p < .
05) in the less severe burn patients (<110 unit burn standard) supplemented
with ornithine alpha-ketoglutarate.
Conclusions: Ornithine alpha-ketoglutarate supplementation of enteral feedi
ng significantly shortens wound healing time in severe burn patients. In ad
dition, ornithine alpha-ketoglutarate administration was safe and well tole
rated and decreased protein hypercatabolism in the less severe burn patient
s.