Multiple Systems Organ Failure: VII. Reduction in Plasma Branched-chain Amino Acids–Correlations with Liver Failure and Amino Acid Infusion

Lower fractional concentrations of branched-chain amino acids were found in trauma-septic patients who did not survive than in those who survived (p values < 0.046 to 0.001). A liver dysfunction scale was constructed on the basis of the levels of plasma bilirubin, albumin, SGOT, prothrombin time, and neurologic encephalopathy. Increased liver dysfunction was associated with reduced plasma fractional branched-chain amino acids for all branched-chain amino acids in both the surviving and nonsurviving patients except for valine in the nonsurviving group. This decrease was statistically significant (p ≤ 0.041 to 0.001) for leucine and isoleucine in the nonsurvivors and for valine in the survivors. The infusion of amino acids was associated with a decrease in the fractional concentrations in the nonsurvivors for leucine and valine and in the survivors for leucine while the fractional concentrations of isoleucine in the nonsurvivors and isoleucine and valine in the survivors rose. The statistically significant changes (p ≤ 0.018 to 0.001) were for leucine in the nonsurvivors and isoleucine and valine in the survivors. When the liver dysfunction and amino acid infusion related changes are taken into account there were no significant differences in the fractional branched-chain concentrations between survivors and nonsurvivors. Liver dysfunction and low fractional branched-chain amino acids were linked in magnitude in a way that is consistent with the low branched-chain amino acids producing the liver dysfunction.