Increasing asymmetric dimethylarginine (ADMA) concentrations on days 1-3 are inversely associated with mortality, however not with the same strength as high ADMA or SDMA concentrations at admission.

We suggest that admission concentrations are the focus of future research on ADMA and SDMA as predictors of mortality or potential therapeutical targets in ICU patients.

In total 567 out of 577 patients had plasma samples from days 1-5.

Plasma concentrations of ADMA and arginine increased from days 1-5.

SDMA concentrations increased from days 1-2, followed by a decrease from days 2-5. Concentrations of homoarginine did not change from days 1-3 but slightly increased from days 3-5.

In total 512 patients were alive 3 days after ICU admission.

Among these patients, a daily twofold increase in ADMA concentration from days 1-3 was associated with decreased mortality in multivariate analysis (HR 0.45; 95% CI 0.21-0.98; p = 0.046).

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