Increased Urinary Loss of Uric Acid in Adults with Acute Respiratory Failure Requiring Mechanical Ventilation* Erika Frischknecht Christensen, M.D.;]an jacobsen, M.D.; Erling Anker-M,ller, M.D.; Peter Schultz, M.D.; and Niels Spangsberg, M. D.
Introduction: The purpose of this study was to test a hypothesis of increased urinary excretion of uric acid as an indicator of adenosine triphosphate (ATP) degradation in adult patients with acute respiratory failure, and to look for a correlation to the clinical outcome. Study Daign: Prospectively 31 patients with acute respiratory failure were studied. The patients were divided into two groups according to the clinical outcome: the need for solely supplemental oxygen (group I), death or mechanical ventilation (group 2). Methoda: Uric acid was determined by spectrophotometry. Heaulta: Mean uric acid excretion was 39 p.mollkg (range,
metabolism requires adequate oxygen supC ellular ply. Hypoxia at the cellular level impairs the
formation of adenosine triphosphate (ATP) from adenosine diphosphate (ADP), and accumulating ADP is degraded to a chain of purine nucleotides, the end product of which is uric acid (Fig 1). Increased ATP degradation products as a marker of ischemia and hypoxia in isolated organs have been shown in animal studies as well as in human studies. i-4 Few clinical For editorial comment see page 329 studies concerning critically ill patients have been done. In hypoxic premature neonates with infant respiratory distress syndrome (IRDS), the urinary loss of uric acid was greater than in neonates without IRDS.5,6 In critically ill adult patients, increased ATP degradation products in plasma was associated with poor prognosis7-g and was found during hypotensive events. lO In these studies, diagnoses were multiple, but some of the patients suffered respiratory failure. Only one study has looked on patients who had hypoxic hypoxemia as the principal diagnoses; this concerned outpatients with sleep-associated hypoxemia, and increased uric acid clearance was found in these patients compared with control subjects. ii The purpose of this study was to describe prospec*From the Department of Anesthesiology, Arhus Amtssygehus, Arhus C, Denmark. This study was ~ted by S~ren J0rgensens Fond, Odense, Denmark. Manuscript received September 27, 1991; revision accepted February 25, 1992.
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7 to 92 p.mollkg) body weight/per 24 h in group 1 (16 patients) compared with 65 p.mollkg/24 h (range, 8 to 253 p.mollkg/24 h) in group 2 (13 patients were mechanically ventilated, and two patients died). The difference was highly signmcant (p
Introduction: The purpose of this study was to test a hypothesis of increased urinary excretion of uric acid as an indicator of adenosine triphosphate (ATP) degradation in adult patients with acute respiratory failure, and to look for a correlation to the clinical outcome. Study Daign: Prospectively 31 patients with acute respiratory failure were studied. The patients were divided into two groups according to the clinical outcome: the need for solely supplemental oxygen (group I), death or mechanical ventilation (group 2). Methoda: Uric acid was determined by spectrophotometry. Heaulta: Mean uric acid excretion was 39 p.mollkg (range,
metabolism requires adequate oxygen supC ellular ply. Hypoxia at the cellular level impairs the
formation of adenosine triphosphate (ATP) from adenosine diphosphate (ADP), and accumulating ADP is degraded to a chain of purine nucleotides, the end product of which is uric acid (Fig 1). Increased ATP degradation products as a marker of ischemia and hypoxia in isolated organs have been shown in animal studies as well as in human studies. i-4 Few clinical For editorial comment see page 329 studies concerning critically ill patients have been done. In hypoxic premature neonates with infant respiratory distress syndrome (IRDS), the urinary loss of uric acid was greater than in neonates without IRDS.5,6 In critically ill adult patients, increased ATP degradation products in plasma was associated with poor prognosis7-g and was found during hypotensive events. lO In these studies, diagnoses were multiple, but some of the patients suffered respiratory failure. Only one study has looked on patients who had hypoxic hypoxemia as the principal diagnoses; this concerned outpatients with sleep-associated hypoxemia, and increased uric acid clearance was found in these patients compared with control subjects. ii The purpose of this study was to describe prospec*From the Department of Anesthesiology, Arhus Amtssygehus, Arhus C, Denmark. This study was ~ted by S~ren J0rgensens Fond, Odense, Denmark. Manuscript received September 27, 1991; revision accepted February 25, 1992.
556
7 to 92 p.mollkg) body weight/per 24 h in group 1 (16 patients) compared with 65 p.mollkg/24 h (range, 8 to 253 p.mollkg/24 h) in group 2 (13 patients were mechanically ventilated, and two patients died). The difference was highly signmcant (p
