Urinary pyridinium cross-link excretion is increased in critically ill surgical patients

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Abstract
Objectives To determine: a) the rate of pyridinium cross-links of collagen excretion, breakdown products of bone, in critically ill surgical patients in the intensive care unit (ICU); and b) the relationship between cross-link excretion and nitrogen excretion and balance to ascertain whether collagen breakdown products contribute to protein losses during a hypercatabolic state. Design Observational study starting on the first postoperative day to 20 days or until discharge. Setting A surgical ICU in a University hospital. Patients Nine mechanically ventilated, postoperative surgical patients (73 +/- 3 [SD] yrs), receiving routine parenteral nutrition (18% protein) and 17 age-matched healthy subjects. Interventions None. Measurements and Main Results Resting energy expenditure was determined daily for 5 days) in the ICU; and c) is independent of the rate of nitrogen excretion. These findings suggest that critically ill postoperative patients experience an acute breakdown of collagen, which is likely due to resorption of bone or possibly comes from other collagen sources. (Crit Care Med 1997; 25:85-90)