{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:46:28Z","timestamp":1790750788917,"version":"4.1.0"},"reference-count":67,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T00:00:00Z","timestamp":1630627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Sepsis biomarkers and potential therapeutic targets are urgently needed. With proton nuclear magnetic resonance (1H NMR) spectroscopy, several metabolites can be assessed simultaneously. Fifty-three adult medical ICU sepsis patients and 25 ICU controls without sepsis were prospectively enrolled. 1H NMR differences between groups and associations with 28-day and ICU mortality were investigated. In multivariate metabolomic analyses, we found separate clustering of ICU controls and sepsis patients, as well as septic shock survivors and non-survivors. Lipoproteins were significantly different between sepsis and control patients. Levels of the branched-chain amino acids (BCAA) valine (median 43.3 [29.0\u201353.7] vs. 64.3 [47.7\u201372.3] normalized signal intensity units; p = 0.005), leucine (57.0 [38.4\u201371.0] vs. 73.0 [54.3\u201386.3]; p = 0.034) and isoleucine (15.2 [10.9\u201321.6] vs. 17.9 [16.1\u201324.4]; p = 0.048) were lower in patients with septic shock compared to those without. Similarly, BCAA were lower in ICU non-survivors compared to survivors, and BCAA were good discriminators for ICU and 28-day mortality. In uni- and multivariable logistic regression analyses, higher BCAA levels were associated with decreased ICU- and 28-day mortality. In conclusion, metabolomics using 1H NMR spectroscopy showed encouraging potential for personalized medicine in sepsis. BCAA was significantly lower in sepsis non-survivors and may be used as early biomarkers for outcome prediction.<\/jats:p>","DOI":"10.3390\/nu13093106","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T13:18:26Z","timestamp":1630934306000},"page":"3106","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Branched-Chain Amino Acids Can Predict Mortality in ICU Sepsis Patients"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5773-5695","authenticated-orcid":false,"given":"Alexander Christian","family":"Reisinger","sequence":"first","affiliation":[{"name":"Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Posch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Oncology, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Hackl","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2422-5381","authenticated-orcid":false,"given":"Gunther","family":"Marsche","sequence":"additional","affiliation":[{"name":"Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-9594","authenticated-orcid":false,"given":"Harald","family":"Sourij","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Bourgeois","sequence":"additional","affiliation":[{"name":"Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6214-5008","authenticated-orcid":false,"given":"Kathrin","family":"Eller","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9725-5231","authenticated-orcid":false,"given":"Tobias","family":"Madl","sequence":"additional","affiliation":[{"name":"Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, 8036 Graz, Austria"},{"name":"BioTechMed Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5537-3646","authenticated-orcid":false,"given":"Philipp","family":"Eller","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1164\/rccm.201504-0781OC","article-title":"Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations","volume":"193","author":"Fleischmann","year":"2016","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1097\/SHK.0000000000000703","article-title":"How Can We Estimate Sepsis Incidence and Mortality?","volume":"47","author":"Gobatto","year":"2017","journal-title":"Shock"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6579","DOI":"10.1038\/s41598-019-42972-7","article-title":"The usefulness of C-reactive protein and procalcitonin to predict prognosis in septic shock patients: A multicenter prospective registry-based observational study","volume":"9","author":"Ryoo","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"579677","DOI":"10.3389\/fmed.2020.579677","article-title":"Arylesterase Activity of HDL Associated Paraoxonase as a Potential Prognostic Marker in Patients With Sepsis and Septic Shock-A Prospective Pilot Study","volume":"7","author":"Reisinger","year":"2020","journal-title":"Front. Med. (Lausanne)"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1039\/C6MB00656F","article-title":"Mass spectrometry for the discovery of biomarkers of sepsis","volume":"13","author":"Ludwig","year":"2017","journal-title":"Mol. Biosyst."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"737","DOI":"10.2217\/pgs.15.20","article-title":"Pharmacometabonomics in humans: A new tool for personalized medicine","volume":"16","author":"Everett","year":"2015","journal-title":"Pharmacogenomics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.ccc.2019.08.008","article-title":"Metabolomics and the Microbiome as Biomarkers in Sepsis","volume":"36","author":"Lee","year":"2020","journal-title":"Crit. Care Clin."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1002\/anie.201804736","article-title":"High-Throughput Metabolomics by 1D NMR","volume":"58","author":"Vignoli","year":"2019","journal-title":"Angew. Chem. Int. Ed. Engl."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1016\/j.cmet.2018.07.021","article-title":"Cytosolic Aspartate Availability Determines Cell Survival When Glutamine Is Limiting","volume":"28","author":"Alkan","year":"2018","journal-title":"Cell Metab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"W486","DOI":"10.1093\/nar\/gky310","article-title":"MetaboAnalyst 4.0: Towards more transparent and integrative metabolomics analysis","volume":"46","author":"Chong","year":"2018","journal-title":"Nucleic Acids Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4281","DOI":"10.1021\/ac051632c","article-title":"Probabilistic quotient normalization as robust method to account for dilution of complex biological mixtures. Application in 1H NMR metabonomics","volume":"78","author":"Dieterle","year":"2006","journal-title":"Anal. Chem."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.bbamcr.2018.08.017","article-title":"N-acetylaspartate pathway is nutrient responsive and coordinates lipid and energy metabolism in brown adipocytes","volume":"1866","author":"Huber","year":"2019","journal-title":"Biochim. Biophys. Acta Mol. Cell Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"7354","DOI":"10.1021\/ac801053g","article-title":"Optimization of human plasma 1H NMR spectroscopic data processing for high-throughput metabolic phenotyping studies and detection of insulin resistance related to type 2 diabetes","volume":"80","author":"Maher","year":"2008","journal-title":"Anal. Chem."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1186\/s13054-019-2478-6","article-title":"Frequency and mortality of septic shock in Europe and North America: A systematic review and meta-analysis","volume":"23","author":"Vincent","year":"2019","journal-title":"Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"ofy313","DOI":"10.1093\/ofid\/ofy313","article-title":"Sepsis in Intensive Care Unit Patients: Worldwide Data From the Intensive Care over Nations Audit","volume":"5","author":"Sakr","year":"2018","journal-title":"Open Forum Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"R15","DOI":"10.1186\/cc8872","article-title":"Sepsis biomarkers: A review","volume":"14","author":"Pierrakos","year":"2010","journal-title":"Crit. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"146","DOI":"10.7861\/clinmedicine.18-2-146","article-title":"Diagnosis and management of sepsis","volume":"18","author":"Evans","year":"2018","journal-title":"Clin. Med. (Lond.)"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1093\/nutrit\/nuy037","article-title":"Immunomodulatory role of branched-chain amino acids","volume":"76","author":"Bonvini","year":"2018","journal-title":"Nutr. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1017\/S000711450769936X","article-title":"Amino acids and immune function","volume":"98","author":"Li","year":"2007","journal-title":"Br. J. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"319S","DOI":"10.1093\/jn\/136.1.319S","article-title":"Potential importance of leucine in treatment of obesity and the metabolic syndrome","volume":"136","author":"Layman","year":"2006","journal-title":"J. Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1113\/JP275075","article-title":"Restoration of metabolic health by decreased consumption of branched-chain amino acids","volume":"596","author":"Cummings","year":"2018","journal-title":"J. Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.celrep.2016.05.092","article-title":"Decreased Consumption of Branched-Chain Amino Acids Improves Metabolic Health","volume":"16","author":"Fontana","year":"2016","journal-title":"Cell Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/00000658-197809000-00017","article-title":"Amino acid derangements in patients with sepsis: Treatment with branched chain amino acid rich infusions","volume":"188","author":"Freund","year":"1978","journal-title":"Ann. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.ccm.2016.01.011","article-title":"Metabolism, Metabolomics, and Nutritional Support of Patients with Sepsis","volume":"37","author":"Englert","year":"2016","journal-title":"Clin. Chest Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1046\/j.1440-1746.2000.02205.x","article-title":"Branched-chain amino acids","volume":"15","author":"Platell","year":"2000","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12986-018-0271-1","article-title":"Branched-chain amino acids in health and disease: Metabolism, alterations in blood plasma, and as supplements","volume":"15","author":"Holecek","year":"2018","journal-title":"Nutr. Metab. (Lond.)"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1001\/archsurg.1986.01400030120019","article-title":"Clinical use of branched-chain amino acids in liver disease, sepsis, trauma, and burns","volume":"121","author":"Sax","year":"1986","journal-title":"Arch. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1177\/0148607191015003252","article-title":"Prospective study on the efficacy of branched-chain amino acids in septic patients","volume":"15","year":"1991","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"460","DOI":"10.3177\/jnsv.54.460","article-title":"The effects of endotoxin on plasma free amino acid concentrations in rats","volume":"54","author":"Asai","year":"2008","journal-title":"J. Nutr. Sci. Vitaminol. (Tokyo)"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"R935","DOI":"10.1152\/ajpregu.00297.2010","article-title":"BCATm deficiency ameliorates endotoxin-induced decrease in muscle protein synthesis and improves survival in septic mice","volume":"299","author":"Lang","year":"2010","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1093\/ajcn\/73.5.908","article-title":"Amino acid kinetics in patients with sepsis","volume":"73","author":"Druml","year":"2001","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Su, L., Li, H., Xie, A., Liu, D., Rao, W., Lan, L., Li, X., Li, F., Xiao, K., and Wang, H. (2015). Dynamic changes in amino acid concentration profiles in patients with sepsis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0121933"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/SHK.0000000000001687","article-title":"Serum Levels of Branched Chain Amino Acids Predict Duration of Cardiovascular Organ Failure in Septic Shock","volume":"56","author":"Puskarich","year":"2021","journal-title":"Shock"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1097\/00003246-199106000-00004","article-title":"Amino acid alterations and encephalopathy in the sepsis syndrome","volume":"19","author":"Sprung","year":"1991","journal-title":"Crit. Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/s13054-019-2456-z","article-title":"Nuclear magnetic resonance-based serum metabolomic analysis reveals different disease evolution profiles between septic shock survivors and non-survivors","volume":"23","author":"Liu","year":"2019","journal-title":"Crit. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1097\/CCM.0000000000000142","article-title":"Metabolic profiling of serum samples by 1H nuclear magnetic resonance spectroscopy as a potential diagnostic approach for septic shock","volume":"42","author":"Mickiewicz","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13054-014-0729-0","article-title":"Integration of metabolic and inflammatory mediator profiles as a potential prognostic approach for septic shock in the intensive care unit","volume":"19","author":"Mickiewicz","year":"2015","journal-title":"Crit. Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"10850","DOI":"10.1021\/ac402235q","article-title":"Metabolic phenotyping of traumatized patients reveals a susceptibility to sepsis","volume":"85","author":"Blaise","year":"2013","journal-title":"Anal. Chem."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e000056","DOI":"10.1136\/bmjresp-2014-000056","article-title":"Discrimination of sepsis stage metabolic profiles with an LC\/MS-MS-based metabolomics approach","volume":"1","author":"Su","year":"2014","journal-title":"BMJ Open Respir. Res."},{"key":"ref_41","first-page":"77","article-title":"The effect of normalization of plasma amino acids on hepatic encephalopathy in man","volume":"80","author":"Fischer","year":"1976","journal-title":"Surgery"},{"key":"ref_42","first-page":"CD001939","article-title":"Branched-chain amino acids for people with hepatic encephalopathy","volume":"5","author":"Gluud","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.jceh.2018.06.004","article-title":"The role of Branched Chain Amino Acids in the treatment of hepatic Encephalopathy","volume":"8","author":"Dam","year":"2018","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.clnu.2018.12.022","article-title":"ESPEN guideline on clinical nutrition in liver disease","volume":"38","author":"Plauth","year":"2019","journal-title":"Clin. Nutr. (Edinb. Scotl.)"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.clnu.2018.08.037","article-title":"ESPEN guideline on clinical nutrition in the intensive care unit","volume":"38","author":"Singer","year":"2019","journal-title":"Clin. Nutr. (Edinb. Scotl.)"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s00134-002-1217-6","article-title":"Amino acid imbalance early in septic encephalopathy","volume":"28","author":"Basler","year":"2002","journal-title":"Intensive Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1097\/00003246-199703000-00008","article-title":"Parenteral administration of different amounts of branch-chain amino acids in septic patients: Clinical and metabolic aspects","volume":"25","author":"Planas","year":"1997","journal-title":"Crit. Care Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/0026-0495(88)90115-1","article-title":"Effect of total parenteral nutrition enriched in branched-chain amino acids on metabolite levels in septic rats","volume":"37","author":"Mori","year":"1988","journal-title":"Metab. Clin. Exp."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/0261-5614(86)90007-5","article-title":"Effects of branched chain enriched amino acid solutions on septic rats","volume":"5","author":"Fujita","year":"1986","journal-title":"Clin. Nutr. (Edinb. Scotl.)"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/BF01658984","article-title":"Prospective randomized double-blind trial of branched chain amino acid enriched versus standard parenteral nutrition solutions in traumatized and septic patients","volume":"15","author":"Vente","year":"1991","journal-title":"World J. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"136937","DOI":"10.1155\/2012\/136937","article-title":"Does Branched-Chain Amino Acids Supplementation Modulate Skeletal Muscle Remodeling through Inflammation Modulation? Possible Mechanisms of Action","volume":"2012","author":"Nicastro","year":"2012","journal-title":"J. Nutr. Metab."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1002\/lt.22324","article-title":"Beneficial effects of supplementation with branched-chain amino acids on postoperative bacteremia in living donor liver transplant recipients","volume":"17","author":"Shirabe","year":"2011","journal-title":"Liver Transpl."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.clnesp.2020.11.015","article-title":"Nutraceuticals for the treatment of sarcopenia in chronic liver disease","volume":"41","author":"Hey","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Hernandez-Conde, M., Llop, E., Gomez-Pimpollo, L., Fernandez Carrillo, C., Rodriguez, L., Van Den Brule, E., Perello, C., Lopez-Gomez, M., Abad, J., and Martinez-Porras, J.L. (2021). Adding Branched-Chain Amino Acids to an Enhanced Standard-of-Care Treatment Improves Muscle Mass of Cirrhotic Patients With Sarcopenia: A Placebo-Controlled Trial. Am. J. Gastroenterol.","DOI":"10.14309\/ajg.0000000000001301"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"15091","DOI":"10.18632\/aging.103576","article-title":"Effects of enriched branched-chain amino acid supplementation on sarcopenia","volume":"12","author":"Ko","year":"2020","journal-title":"Aging (Albany NY)"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.nut.2014.07.005","article-title":"Sarcopenia impairs prognosis of patients with liver cirrhosis","volume":"31","author":"Hanai","year":"2015","journal-title":"Nutrition"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.clnesp.2019.07.011","article-title":"Nutritional support in cirrhotic patients with sarcopenia","volume":"33","author":"Vasques","year":"2019","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s13539-014-0138-x","article-title":"An overview of amines as nutritional supplements to counteract cancer cachexia","volume":"5","author":"Andrade","year":"2014","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1024\/0300-9831\/a000543","article-title":"Effect of branched-Chain Amino Acid Supplementation on Muscle Soreness following Exercise: A Meta-Analysis","volume":"89","author":"Fedewa","year":"2019","journal-title":"Int. J. Vitam. Nutr. Res."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Park, S., Chae, M., Park, H., and Park, K. (2021). Higher Branched-Chain Amino Acid Intake Is Associated with Handgrip Strength among Korean Older Adults. Nutrients, 13.","DOI":"10.3390\/nu13051522"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1139\/apnm-2016-0569","article-title":"The effects of acute branched-chain amino acid supplementation on recovery from a single bout of hypertrophy exercise in resistance-trained athletes","volume":"42","author":"Waldron","year":"2017","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"VanDusseldorp, T.A., Escobar, K.A., Johnson, K.E., Stratton, M.T., Moriarty, T., Cole, N., McCormick, J.J., Kerksick, C.M., Vaughan, R.A., and Dokladny, K. (2018). Effect of Branched-Chain Amino Acid Supplementation on Recovery Following Acute Eccentric Exercise. Nutrients, 10.","DOI":"10.3390\/nu10101389"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.jcrc.2018.03.019","article-title":"Impact of sarcopenic obesity on 30-day mortality in critically ill patients with intra-abdominal sepsis","volume":"46","author":"Ji","year":"2018","journal-title":"J. Crit. Care"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e0171","DOI":"10.1097\/CCE.0000000000000171","article-title":"Skeletal Muscle Composition Predicts Outcome in Critically Ill Patients","volume":"2","author":"Loosen","year":"2020","journal-title":"Crit. Care Explor."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Cox, M.C., Booth, M., Ghita, G., Wang, Z., Gardner, A., Hawkins, R.B., Darden, D.B., Leeuwenburgh, C., Moldawer, L.L., and Moore, F.A. (2021). The impact of sarcopenia and acute muscle mass loss on long-term outcomes in critically ill patients with intra-abdominal sepsis. J. Cachexia Sarcopenia Muscle.","DOI":"10.1002\/jcsm.12752"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"308S","DOI":"10.1093\/jn\/136.1.308S","article-title":"Therapeutic use of branched-chain amino acids in burn, trauma, and sepsis","volume":"136","author":"Cynober","year":"2006","journal-title":"J. Nutr."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/SHK.0000000000000406","article-title":"Whole Blood Reveals More Metabolic Detail of the Human Metabolome than Serum as Measured by 1H-NMR Spectroscopy: Implications for Sepsis Metabolomics","volume":"44","author":"Stringer","year":"2015","journal-title":"Shock"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/9\/3106\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:56:06Z","timestamp":1760165766000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/9\/3106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,3]]},"references-count":67,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["nu13093106"],"URL":"https:\/\/doi.org\/10.3390\/nu13093106","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,3]]}}}