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Montcusí B, Madrid-Gambin F, Pozo ÓJ, Marco S, Marin S, Mayol X, Pascual M, Alonso S, Salvans S, Jiménez-Toscano M, Cascante M, Pera M. Circulating metabolic markers after surgery identify patients at risk for severe postoperative complications: a prospective cohort study in colorectal cancer. Int J Surg 2024; 110:1493-1501. [PMID: 38116682 PMCID: PMC10942180 DOI: 10.1097/js9.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Early detection of postoperative complications after colorectal cancer (CRC) surgery is associated with improved outcomes. The aim was to investigate early metabolomics signatures capable to detect patients at risk for severe postoperative complications after CRC surgery. MATERIALS AND METHODS Prospective cohort study of patients undergoing CRC surgery from 2015 to 2018. Plasma samples were collected before and after surgery, and analyzed by mass spectrometry obtaining 188 metabolites and 21 ratios. Postoperative complications were registered with Clavien-Dindo Classification and Comprehensive Complication Index. RESULTS One hundred forty-six patients were included. Surgery substantially modified metabolome and metabolic changes after surgery were quantitatively associated with the severity of postoperative complications. The strongest positive relationship with both Clavien-Dindo and Comprehensive Complication Index (β=4.09 and 63.05, P <0.001) corresponded to kynurenine/tryptophan, against an inverse relationship with lysophosphatidylcholines (LPCs) and phosphatidylcholines (PCs). Patients with LPC18:2/PCa36:2 below the cut-off 0.084 µM/µM resulted in a sevenfold higher risk of major complications (OR=7.38, 95% CI: 2.82-21.25, P <0.001), while kynurenine/tryptophan above 0.067 µM/µM a ninefold (OR=9.35, 95% CI: 3.03-32.66, P <0.001). Hexadecanoylcarnitine below 0.093 µM displayed a 12-fold higher risk of anastomotic leakage-related complications (OR=11.99, 95% CI: 2.62-80.79, P =0.004). CONCLUSION Surgery-induced phospholipids and amino acid dysregulation is associated with the severity of postoperative complications after CRC surgery, including anastomotic leakage-related outcomes. The authors provide quantitative insight on metabolic markers, measuring vulnerability to postoperative morbidity that might help guide early decision-making and improve surgical outcomes.
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Affiliation(s)
- Blanca Montcusí
- Department of Surgery, Section of Colon and Rectal Surgery, Hospital del Mar
- Colorectal Neoplasms Clinical and Translational Research Group
- Applied Metabolomics Research Group, Hospital del Mar Medical Research Institute (IMIM)
- Department of Surgery, Faculty of Medicine, Universitat de Barcelona (UB)
| | - Francisco Madrid-Gambin
- Applied Metabolomics Research Group, Hospital del Mar Medical Research Institute (IMIM)
- Signal and Information Processing for Sensing Systems, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology
| | - Óscar J Pozo
- Applied Metabolomics Research Group, Hospital del Mar Medical Research Institute (IMIM)
| | - Santiago Marco
- Signal and Information Processing for Sensing Systems, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology
- Department of Electronics and Biomedical Engineering, Faculty of Physics
| | - Silvia Marin
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology
- Institute of Biomedicine, Universitat de Barcelona (UB)
- CIBER of Hepatic and Digestive Diseases (CIBEREHD), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Xavier Mayol
- Colorectal Neoplasms Clinical and Translational Research Group
| | - Marta Pascual
- Department of Surgery, Section of Colon and Rectal Surgery, Hospital del Mar
- Colorectal Neoplasms Clinical and Translational Research Group
| | - Sandra Alonso
- Department of Surgery, Section of Colon and Rectal Surgery, Hospital del Mar
- Colorectal Neoplasms Clinical and Translational Research Group
| | - Silvia Salvans
- Department of Surgery, Section of Colon and Rectal Surgery, Hospital del Mar
- Colorectal Neoplasms Clinical and Translational Research Group
| | - Marta Jiménez-Toscano
- Department of Surgery, Section of Colon and Rectal Surgery, Hospital del Mar
- Colorectal Neoplasms Clinical and Translational Research Group
| | - Marta Cascante
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology
- Institute of Biomedicine, Universitat de Barcelona (UB)
- CIBER of Hepatic and Digestive Diseases (CIBEREHD), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Miguel Pera
- Department of Surgery, Section of Colon and Rectal Surgery, Hospital del Mar
- Colorectal Neoplasms Clinical and Translational Research Group
- Department of Surgery, Faculty of Medicine, Universitat de Barcelona (UB)
- Department of General and Digestive Surgery, Institut of Digestive and Metabolic Diseases, Hospital Clínic, Barcelona
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You H, Hou X, Zhang H, Li X, Feng X, Qian X, Shi N, Guo R, Wang X, Sun H, Feng W, Li G, Zheng Z, Chen Y. Effect of glycemic control and glucose fluctuation on in-hospital adverse outcomes after on-pump coronary artery bypass grafting in patients with diabetes: a retrospective study. Diabetol Metab Syndr 2023; 15:20. [PMID: 36788548 PMCID: PMC9930270 DOI: 10.1186/s13098-023-00984-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The optimal glycemic control level in diabetic patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (On-Pump) remains unclear. Therefore, this study aimed to investigate the effect of different blood glucose control levels and glucose fluctuations on in-hospital adverse outcomes in diabetic patients undergoing on-pump CABG. METHOD A total of 3918 patients with diabetes undergoing CABG were reviewed in this study. A total of 1638 patients were eligible for inclusion and were categorized into strict, moderate and liberal glucose control groups based on post-operative mean blood glucose control levels of < 7.8 mmol/L, from 7.8 to 9.9 mmol/L and ≥ 10.0 mmoL/L, respectively. The primary endpoint was defined as a composite endpoint including in-hospital all-cause mortality and major cardiovascular complications. The secondary endpoint was defined as major cardiovascular complications including acute myocardial infarction, strokes and acute kidney injuries. To determine the associations between blood glucose fluctuations and adverse outcomes, patients with different glycemic control levels were further divided into subgroups according to whether the largest amplitude of glycemic excursion (LAGE) was ≥ 4.4 mmol/L or not. RESULTS A total of 126 (7.7%) patients had a composite endpoint. Compared with moderate control, strict glucose control was associated with an increased risk of the primary endpoint (adjusted OR = 2.22, 95% CI 1.18-4.15, p = 0.01) and the secondary endpoint (adjusted OR = 1.95, 95% CI 1.01-3.77, p = 0.049). Furthermore, LAGE ≥ 4.4 mmol/L was significantly associated with the primary endpoint (adjusted OR = 1.67, 95% CI 1.12-2.50, p = 0.01) and the secondary endpoint (adjusted OR = 1.75, 95% CI 1.17-2.62, p = 0.01),respectively. Patients with LAGE ≥ 4.4 mmol/L had significantly higher rates of the composite endpoint and major vascular complications in both the strict-control (the primary endpoint, 66.7% vs 12.4%, p = 0.034, the secondary endpoint, 66.7% vs 10.3%, p = 0.03) and moderate-control groups (the primary endpoint, 10.2% vs 6.0%, p = 0.03, the secondary endpoint, 10.2% vs 5.8%, p = 0.02). CONCLUSIONS After On-Pump CABG patients with diabetes, strict glucose control (< 7.8 mmol/L) and relatively large glucose fluctuations (LAGE ≥ 4.4 mmol/L) were independently associated with in-hospital adverse outcomes.
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Affiliation(s)
- Hongzhao You
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xiaopei Hou
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Heng Zhang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojue Li
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xinxing Feng
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xin Qian
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Na Shi
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Rong Guo
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xuan Wang
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Hansong Sun
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangwei Li
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Zhe Zheng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yanyan Chen
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
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Kirov H, Doenst T. Metabolomische Charakterisierung von herzchirurgischen Patienten mit Leberdysfunktion – COINTREAU-Trial. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2023. [DOI: 10.1007/s00398-023-00561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Ito T, Sugasawa G, Suzuki F, Sunada M, Iwamuro K, Nakano T, Saito M, Maeba S. Insulin and glucose infusion could prevent euglycemic diabetic ketoacidosis associated with sodium-glucose cotransporter 2 inhibitors. Indian J Thorac Cardiovasc Surg 2022; 38:87-91. [PMID: 34898883 PMCID: PMC8630337 DOI: 10.1007/s12055-021-01227-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/31/2021] [Accepted: 06/13/2021] [Indexed: 01/03/2023] Open
Abstract
Perioperative euglycemic diabetic ketoacidosis (euDKA) is a serious adverse effect of sodium-glucose cotransporter 2 inhibitor (SGLT2i) treatment. We observed perioperative euDKA immediately after discontinuing insulin infusion that was started during surgery in a patient with type 2 diabetes mellitus (T2DM) for whom empagliflozin could not be withdrawn before emergency off-pump coronary artery bypass grafting (OPCAB). Insulin infusion that was started during surgery unexpectedly prevented euDKA until its discontinuation. Therefore, we hypothesized that insulin and glucose infusion initiated at the start of emergency surgery in patients receiving SGLT2is prevents perioperative euDKA. We implemented this strategy during emergency OPCAB in another patient with T2DM who received empagliflozin 2 days before surgery and observed that the patient did not develop perioperative euDKA. With the increasing use of SGLT2is, surgeons may encounter more SGLT2i users who require emergency surgeries. The administration of insulin and glucose infusion in advance emergency surgery can prevent perioperative euDKA.
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Affiliation(s)
- Takuya Ito
- Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo, Japan
| | - Gen Sugasawa
- Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo, Japan
| | - Fumitaka Suzuki
- Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo, Japan
| | | | - Kenji Iwamuro
- Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo, Japan
| | | | | | - Satoru Maeba
- Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo, Japan
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Khan T, Loftus TJ, Filiberto AC, Ozrazgat-Baslanti T, Ruppert MM, Bandhyopadyay S, Laiakis EC, Arnaoutakis DJ, Bihorac A. Metabolomic Profiling for Diagnosis and Prognostication in Surgery: A Scoping Review. Ann Surg 2021; 273:258-268. [PMID: 32482979 PMCID: PMC7704904 DOI: 10.1097/sla.0000000000003935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This review assimilates and critically evaluates available literature regarding the use of metabolomic profiling in surgical decision-making. BACKGROUND Metabolomic profiling is performed by nuclear magnetic resonance spectroscopy or mass spectrometry of biofluids and tissues to quantify biomarkers (ie, sugars, amino acids, and lipids), producing diagnostic and prognostic information that has been applied among patients with cardiovascular disease, inflammatory bowel disease, cancer, and solid organ transplants. METHODS PubMed was searched from 1995 to 2019 to identify studies investigating metabolomic profiling of surgical patients. Articles were included and assimilated into relevant categories per PRISMA-ScR guidelines. Results were summarized with descriptive analytical methods. RESULTS Forty-seven studies were included, most of which were retrospective studies with small sample sizes using various combinations of analytic techniques and types of biofluids and tissues. Results suggest that metabolomic profiling has the potential to effectively screen for surgical diseases, suggest diagnoses, and predict outcomes such as postoperative complications and disease recurrence. Major barriers to clinical adoption include a lack of high-level evidence from prospective studies, heterogeneity in study design regarding tissue and biofluid procurement and analytical methods, and the absence of large, multicenter metabolome databases to facilitate systematic investigation of the efficacy, reproducibility, and generalizability of metabolomic profiling diagnoses and prognoses. CONCLUSIONS Metabolomic profiling research would benefit from standardization of study design and analytic approaches. As technologies improve and knowledge garnered from research accumulates, metabolomic profiling has the potential to provide personalized diagnostic and prognostic information to support surgical decision-making from preoperative to postdischarge phases of care.
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Affiliation(s)
- Tabassum Khan
- Department of Surgery, University of Florida, Gainesville,
FL, USA
| | - Tyler J. Loftus
- Department of Surgery, University of Florida, Gainesville,
FL, USA
| | | | - Tezcan Ozrazgat-Baslanti
- Department of Medicine, University of Florida, Gainesville,
FL, USA
- Precision and Intelligent Systems in Medicine (PrismaP),
University of Florida, Gainesville, FL
| | | | - Sabyasachi Bandhyopadyay
- Department of Medicine, University of Florida, Gainesville,
FL, USA
- Precision and Intelligent Systems in Medicine (PrismaP),
University of Florida, Gainesville, FL
| | - Evagelia C. Laiakis
- Department of Oncology, Georgetown University, Washington
DC, USA
- Department of Biochemistry and Molecular & Cellular
Biology, Georgetown University, Washington DC, USA
| | | | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville,
FL, USA
- Precision and Intelligent Systems in Medicine (PrismaP),
University of Florida, Gainesville, FL
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Kemp PR, Paul R, Hinken AC, Neil D, Russell A, Griffiths MJ. Metabolic profiling shows pre-existing mitochondrial dysfunction contributes to muscle loss in a model of ICU-acquired weakness. J Cachexia Sarcopenia Muscle 2020; 11:1321-1335. [PMID: 32677363 PMCID: PMC7567140 DOI: 10.1002/jcsm.12597] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 05/01/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Surgery can lead to significant muscle loss, which increases recovery time and associates with increased mortality. Muscle loss is not uniform, with some patients losing significant muscle mass and others losing relatively little, and is likely to be accompanied by marked changes in circulating metabolites and proteins. Determining these changes may help understand the variability and identify novel therapeutic approaches or markers of muscle wasting. METHODS To determine the association between muscle loss and circulating metabolites, we studied 20 male patients (median age, 70.5, interquartile range, 62.5-75) undergoing aortic surgery. Muscle mass was determined before and 7 days after surgery and blood samples were taken before surgery, and 1, 3, and 7 days after surgery. The circulating metabolome and proteome were determined using commercial services (Metabolon and SomaLogic). RESULTS Ten patients lost more than 10% of the cross-sectional area of the rectus femoris (RFCSA ) and were defined as wasting. Metabolomic analysis showed that 557 circulating metabolites were altered following surgery (q < 0.05) in the whole cohort and 104 differed between wasting and non-wasting patients (q < 0.05). Weighted genome co-expression network analysis, identified clusters of metabolites, both before and after surgery, that associated with muscle mass and function (r = -0.72, p = 6 × 10-4 with RFCSA on Day 0, P = 3 × 10-4 with RFCSA on Day 7 and r = -0.73, P = 5 × 10-4 with hand-grip strength on Day 7). These clusters were mainly composed of acyl carnitines and dicarboxylates indicating that pre-existing mitochondrial dysfunction contributes to muscle loss following surgery. Surgery elevated cortisol to the same extent in wasting and non-wasting patients, but the cortisol:cortisone ratio was higher in the wasting patients (Day 3 P = 0.043 and Day 7 P = 0.016). Wasting patients also showed a greater increase in circulating nucleotides 3 days after surgery. Comparison of the metabolome with inflammatory markers identified by SOMAscan® showed that pre-surgical mitochondrial dysfunction was associated with growth differentiation factor 15 (GDF-15) (r = 0.79, P = 2 × 10-4 ) and that GDF-15, interleukin (IL)-8), C-C motif chemokine 23 (CCL-23), and IL-15 receptor subunit alpha (IL-15RA) contributed to metabolic changes in response to surgery. CONCLUSIONS We show that pre-existing mitochondrial dysfunction and reduced cortisol inactivation contribute to muscle loss following surgery. The data also implicate GDF-15 and IL-15RA in mitochondrial dysfunction.
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Affiliation(s)
- Paul R Kemp
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - Richard Paul
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK.,Department of Intensive Care, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Aaron C Hinken
- Muscle Metabolism Discovery Performance Unit, GlaxoSmithKline, Inc, Collegeville, PA, USA
| | - David Neil
- Muscle Metabolism Discovery Performance Unit, GlaxoSmithKline, Inc, Collegeville, PA, USA
| | - Alan Russell
- Muscle Metabolism Discovery Performance Unit, GlaxoSmithKline, Inc, Collegeville, PA, USA.,Edgewise Therapeutics, Boulder, CO, USA
| | - Mark J Griffiths
- Cardiovascular and Respiratory Interface Section, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
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Davidson JA, Pfeifer Z, Frank B, Tong S, Urban TT, Wischmeyer PA, Mourani P, Landeck B, Christians U, Klawitter J. Metabolomic Fingerprinting of Infants Undergoing Cardiopulmonary Bypass: Changes in Metabolic Pathways and Association With Mortality and Cardiac Intensive Care Unit Length of Stay. J Am Heart Assoc 2018; 7:e010711. [PMID: 30561257 PMCID: PMC6405618 DOI: 10.1161/jaha.118.010711] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/08/2018] [Indexed: 12/30/2022]
Abstract
Background Mortality for infants undergoing complex cardiac surgery is >10% with a 30% to 40% risk of complications. Early identification and treatment of high-risk infants remains challenging. Metabolites are small molecules that determine the minute-to-minute cellular phenotype, making them ideal biomarkers for postsurgical monitoring and potential targets for intervention. Methods and Results We measured 165 serum metabolites by tandem mass spectroscopy in infants ≤120 days old undergoing cardiopulmonary bypass. Samples were collected prebypass, during rewarming, and 24 hours after surgery. Partial least squares-discriminant analysis, pathway analysis, and receiver operator characteristic curve analysis were used to evaluate changes in the metabolome, assess altered metabolic pathways, and discriminate between survivors/nonsurvivors as well as upper/lower 50% intensive care unit length of stay. Eighty-two infants had preoperative samples for analysis; 57 also had rewarming and 24-hour samples. Preoperation, the metabolic fingerprint of neonates differed from older infants ( R2=0.89, Q2=0.77; P<0.001). Cardiopulmonary bypass resulted in progressive, age-independent metabolic disturbance ( R2=0.92, Q2=0.83; P<0.001). Multiple pathways demonstrated changes, with arginine/proline ( P=1.2×10-35), glutathione ( P=3.3×10-39), and alanine/aspartate/glutamate ( P=1.4×10-26) metabolism most affected. Six subjects died. Nonsurvivors demonstrated altered aspartate ( P=0.007) and nicotinate/nicotinamide metabolism ( P=0.005). The combination of 24-hour aspartate and methylnicotinamide identified nonsurvivors versus survivors (area under the curve, 0.86; P<0.01), as well as upper/lower 50% intensive care unit length of stay (area under the curve, 0.89; P<0.01). Conclusions The preoperative metabolic fingerprint of neonates differed from older infants. Large metabolic shifts occurred after cardiopulmonary bypass, independent of age. Nonsurvivors and subjects requiring longer intensive care unit length of stay showed distinct changes in metabolism. Specific metabolites, including aspartate and methylnicotinamide, may differentiate sicker patients from those experiencing a more benign course.
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Affiliation(s)
- Jesse A. Davidson
- Department of PediatricsUniversity of Colorado/Children's Hospital ColoradoAuroraCO
| | | | - Benjamin Frank
- Department of PediatricsUniversity of Colorado/Children's Hospital ColoradoAuroraCO
| | - Suhong Tong
- Department of BiostatisticsUniversity of Colorado/Children's Hospital ColoradoAuroraCO
| | - Tracy T. Urban
- Department of Research InstituteChildren's Hospital ColoradoAuroraCO
| | | | - Peter Mourani
- Department of PediatricsUniversity of Colorado/Children's Hospital ColoradoAuroraCO
| | - Bruce Landeck
- Department of PediatricsUniversity of Colorado/Children's Hospital ColoradoAuroraCO
| | - Uwe Christians
- Department of AnesthesiologyUniversity of ColoradoAuroraCO
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Deidda M, Noto A, Bassareo PP, Cadeddu Dessalvi C, Mercuro G. Metabolomic Approach to Redox and Nitrosative Reactions in Cardiovascular Diseases. Front Physiol 2018; 9:672. [PMID: 29997515 PMCID: PMC6031070 DOI: 10.3389/fphys.2018.00672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/15/2018] [Indexed: 11/16/2022] Open
Abstract
Metabolomics, also referred to as metabonomics, is one of the most recent innovative technologies in medicine. It offers a direct functional read-out of phenotypes by the detection, identification, and quantification of a large number of metabolites within a biological sample such as urine and blood. Metabolites (<1500 Da) represent the output of cellular metabolism, accounting for expression and activity of genes, transcripts, and proteins, and offering unique insights into small molecule regulation, which may uncover new biochemical patterns. Metabolomics research has considerable potential for translating the metabolic fingerprint into personalized therapeutic strategies. Within the field of interest, cardiovascular disease (CVD) is one of the most developed areas. However, CVD remains the leading cause of death worldwide with a marked increase in mortality rates over the past six decades. In this scenario, recent findings indicate the important role of redox and nitrosative (RN) reactions in CVD development and progression. RN reactions are generally involved in the homeostatic modulation of a wide number of cellular and organ functions. Conversely, the imbalance of these reactions may lead to a condition of allostasis that in turn can cause CVD. The aim of this review is to highlight how the use of metabolomics may be useful for the study of RN reactions related to CVD, providing a tool to understand the mechanisms underlying reactions that could lead to impaired ROS or RNS formation.
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Affiliation(s)
- Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, Sardinia, Italy
| | - Antonio Noto
- Department of Medical Sciences and Public Health, University of Cagliari, Sardinia, Italy
| | - Pier P Bassareo
- Department of Medical Sciences and Public Health, University of Cagliari, Sardinia, Italy
| | | | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Sardinia, Italy
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