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Am J Physiol Endocrinol Metab 273: E898-E902, 1997;
0193-1849/97 $5.00
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Vol. 273, Issue 5, E898-E902, November 1997

Albumin and fibrinogen syntheses increase while muscle protein synthesis decreases in head-injured patients

Odile Mansoor1,3, Marc Cayol2, Pierre Gachon3, Yves Boirie3, Pierre Schoeffler1, Christiane Obled2, and Bernard Beaufrère3

1 Département de Réanimation, Centre Hospitalier Universitaire, 63003 Clermont Ferrand; 2 Unité d'Etude du Métabolisme Azoté, Institut National de la Recherche Agronomique de Theix, 63122 St. Genès-Champandle; and 3 Laboratoire de Nutrition Humaine, Université d'Auvergne Centre de Recherche en Nutrition Humaine, 63009 Clermont-Ferrand, France

The effect of trauma on protein metabolism was investigated in the whole body, muscle, and liver in severely head-injured patients presenting an acute inflammatory response by comparison to fed control subjects receiving a similar diet. Nonoxidative leucine disposal (an index of whole body protein synthesis) and muscle, albumin, and fibrinogen synthesis were determined by means of a primed, continuous infusion of L-[1-13C]leucine. Nonoxidative leucine disposal increased by 28% in the patients (P < 0.02). Fractional muscle protein synthesis rate decreased by 50% (P < 0.01) after injury. Fractional and absolute fribrinogen synthesis rates were multiplied by two and nine, respectively, after injury (P < 0.001). Albumin levels were lower in patients (25.2 ± 1.2 g/l, means ± SE) than in controls (33.7 ± 1.2 g/l, P < 0.001). However, fractional albumin synthesis rates were increased by 60% in patients (11.4 ± 1.0%/day) compared with controls (7.3 ± 0.4%/day, P < 0.01). Therefore, 1) head trauma induces opposite and large changes of protein synthesis in muscle and acute-phase hepatic proteins, probably mediated by cytokines, glucocorticoids, and other stress hormones, and 2) in these patients, hypoalbuminemia is not due to a depressed albumin synthesis.

inflammation; cytokines; leucine; tracers


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