Urinary excretion of polyamines in patients with surgical and accidental trauma: Effect of total parenteral nutrition

Excretion of polyamines first increases and then decreases in patients with multiple trauma receiving total parenteral nutrition (TPN). To separate the effects of trauma and TPN on polyamine excretion, we studied 12 patients with multiple trauma and 14 patients after surgery for colorectal malignancy. Patients were randomized to receive either TPN or hypocaloric glucose infusion. Urinary excretion of total and free polyamines, putrescine (PU), spermidine (SPD), and spermine (SP), and their metabolites, N1-acetylspermidine (N1-AcSPD) and N8-acetylspermidine (N8-AcSPD), and energy and nitrogen balance were measured. Polyamine excretion, excluding SP, markedly increased after trauma and surgery, exceeding the normal values by twofold to 10-fold. In patients receiving TPN, the excretion of total polyamines was 48% higher (P < .01), PU was 34% higher (P < .05), SPD was 35% higher (P < .05), and SP was 350% higher (P < .05) than in patients receiving hypocaloric glucose. Urinary excretion of SP was only 17% of the reference value during hypocaloric glucose (P < .05), but was normal during TPN. The difference in polyamine excretion between nutrition groups was more pronounced when normalized for nitrogen or energy balance. Patients receiving TPN were more hypermetabolic than patients receiving hypocaloric glucose (resting energy expenditure, 1.36 ± 0.06 [SE] and 1.16 ± 0.04 times predicted values, respectively; P < .025). Statistically, energy expenditure could explain the difference in polyamine excretion between nutrition groups. Excretion of N1-AcSPD was 116% higher (P < .001), N8-AcSPD was 72% higher (P < .01), and total SPD was 123% higher (P < .001) in patients with multiple trauma than in patients who had undergone elective surgery, and the difference in N1-AcSPD and N8-AcSPD could be explained by differences in nitrogen and energy balance between patient groups. In conclusion, TPN enhanced the already increased polyamine excretion in posttrauma and postsurgical patients. Excretion of N1-AcSPD and N8-AcSPD reflected the catabolic response to injury within each nutrition group. Our results suggest that urinary excretion of polyamines reflects metabolic activity in general rather than a solitary effect of a specific disease or therapy.