Low serum citrulline concentration correlates with catheter-related bloodstream infections in children with intestinal failure

Melissa A. Hull, Brian A. Jones, David Zurakowski, Bram Raphael, Clifford Lo, Tom Jaksic, Christopher Duggan

Research output: Contribution to journalArticle

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Abstract

Background: Serum citrulline concentration is used as a biomarker of enterocyte mass and enteral tolerance, and low serum concentrations are correlated with bacteremia in immunosuppressed adults undergoing hematopoietic stem cell transplant. The authors sought to determine if citrulline was associated with the development of catheter-related bloodstream infections (CRBSIs) in children with intestinal failure. Methods: Data were reviewed from 66 children treated in a multidisciplinary intestinal rehabilitation program, who had serum concentration citrulline measured between January 2007 and August 2009. All patients had a diagnosis of intestinal failure requiring parenteral nutrition (PN) support. Exclusion criteria included central venous catheter in situ <30 days, creatinine clearance <20 mL/ minute, or a history of organ transplant/immunosuppression. Results: A total of 15 patients were excluded because of the above criteria. In this cohort of 51 patients, 26 (51%) developed CRBSIs. Both groups were similar in terms of gestational age, diagnosis, nutrition status, and biochemical liver function tests. The mean (± standard deviation [SD]) minimum serum citrulline concentration was significantly lower in patients who developed CRBSIs (6.7 ± 4.6 μmol/L) than in those who did not (11.3 ± 6.4 μmol/L, P =.004). Multivariate logistic regression analysis identified lower minimum serum citrulline concentration and longer central venous catheter duration as independently associated with CRBSI (P =.003 and P =.038, respectively). Conclusions: Low serum citrulline concentration and longer central venous catheter time are independently associated with CRBSI in children with intestinal failure. Serum citrulline concentration may be a useful biomarker to identify patients with intestinal failure who are at high risk of developing a CRBSI.

Original languageEnglish (US)
Pages (from-to)181-187
Number of pages7
JournalJournal of Parenteral and Enteral Nutrition
Volume35
Issue number2
DOIs
StatePublished - Mar 1 2011

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Catheter-Related Infections
Citrulline
Serum
Central Venous Catheters
Biomarkers
Transplants
Enterocytes
Liver Function Tests
Parenteral Nutrition
Bacteremia
Hematopoietic Stem Cells
Nutritional Status
Immunosuppression
Gestational Age
Small Intestine
Creatinine
Rehabilitation
Logistic Models
Regression Analysis

Keywords

  • biomarker
  • catheter-related bloodstream infection
  • central venous catheter
  • citrulline

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Low serum citrulline concentration correlates with catheter-related bloodstream infections in children with intestinal failure. / Hull, Melissa A.; Jones, Brian A.; Zurakowski, David; Raphael, Bram; Lo, Clifford; Jaksic, Tom; Duggan, Christopher.

In: Journal of Parenteral and Enteral Nutrition, Vol. 35, No. 2, 01.03.2011, p. 181-187.

Research output: Contribution to journalArticle

Hull, Melissa A. ; Jones, Brian A. ; Zurakowski, David ; Raphael, Bram ; Lo, Clifford ; Jaksic, Tom ; Duggan, Christopher. / Low serum citrulline concentration correlates with catheter-related bloodstream infections in children with intestinal failure. In: Journal of Parenteral and Enteral Nutrition. 2011 ; Vol. 35, No. 2. pp. 181-187.
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AB - Background: Serum citrulline concentration is used as a biomarker of enterocyte mass and enteral tolerance, and low serum concentrations are correlated with bacteremia in immunosuppressed adults undergoing hematopoietic stem cell transplant. The authors sought to determine if citrulline was associated with the development of catheter-related bloodstream infections (CRBSIs) in children with intestinal failure. Methods: Data were reviewed from 66 children treated in a multidisciplinary intestinal rehabilitation program, who had serum concentration citrulline measured between January 2007 and August 2009. All patients had a diagnosis of intestinal failure requiring parenteral nutrition (PN) support. Exclusion criteria included central venous catheter in situ <30 days, creatinine clearance <20 mL/ minute, or a history of organ transplant/immunosuppression. Results: A total of 15 patients were excluded because of the above criteria. In this cohort of 51 patients, 26 (51%) developed CRBSIs. Both groups were similar in terms of gestational age, diagnosis, nutrition status, and biochemical liver function tests. The mean (± standard deviation [SD]) minimum serum citrulline concentration was significantly lower in patients who developed CRBSIs (6.7 ± 4.6 μmol/L) than in those who did not (11.3 ± 6.4 μmol/L, P =.004). Multivariate logistic regression analysis identified lower minimum serum citrulline concentration and longer central venous catheter duration as independently associated with CRBSI (P =.003 and P =.038, respectively). Conclusions: Low serum citrulline concentration and longer central venous catheter time are independently associated with CRBSI in children with intestinal failure. Serum citrulline concentration may be a useful biomarker to identify patients with intestinal failure who are at high risk of developing a CRBSI.

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