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Valdés-Duque BE, Giraldo-Giraldo NA, Jaillier-Ramírez AM, Giraldo-Villa A, Acevedo-Castaño I, Yepes-Molina MA, Barbosa-Barbosa J, Barrera-Causil CJ, Agudelo-Ochoa GM. Stool Short-Chain Fatty Acids in Critically Ill Patients with Sepsis. J Am Coll Nutr 2020; 39:706-712. [PMID: 32163012 DOI: 10.1080/07315724.2020.1727379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: To determine the concentration of stool short-chain fatty acids (SCFAs) in critically ill patients with sepsis and to compare the results between the critically ill patient and the control group.Methods: This descriptive, multicenter, observational study was conducted in five health institutions. Over a 6-month study period, critically ill patients with sepsis who were admitted to the intensive care unit (ICU) and met the inclusion criteria were enrolled, and a control, paired by age and sex, was recruited for each patient. A spontaneous stool sample was collected from each participant and a gas chromatograph coupled to a mass spectrometer (Agilent 7890/MSD 5975 C) was used to measure the concentrations SCFAs.Results: The final sample included 44 patients and 45 controls. There were no differences in the age and sex distributions between the groups (p > 0.05). According to body mass index (BMI), undernutrition was more prevalent among critically ill patients, and BMI in control subjects was most frequently classified as overweight (p = 0.024). Propionic acid, acetic acid, butyric acid, and isobutyric acid concentrations were significantly lower in the critically ill patient group than in the control group (p = 0.000). No association with outcome variables (complications, ICU stay, and discharge condition) was found in the patients, and patients diagnosed with infection on ICU admission showed significant decreases in butyric and isobutyric acid concentrations with respect to other diagnostic criteria (p < 0.05).Conclusions: The results confirm significantly lower concentrations of stool SCFAs in critically ill patients with sepsis than in control subjects. Due to its role in intestinal integrity, barrier function, and anti-inflammatory effect, maintaining the concentration of SCFAs may be important in the ICU care protocols of the critical patient.
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Affiliation(s)
- Beatriz E Valdés-Duque
- Bioscience Research Group, Institución Universitaria Colegio Mayor de Antioquia - IUCMA, Medellín, Antioquia, Colombia
| | - Nubia A Giraldo-Giraldo
- Food and Human Nutrition Research Group, Universidad de Antioquia - UdeA, Medellín, Antioquia, Colombia
| | - Ana M Jaillier-Ramírez
- Departamento de nutrición, Hospital Universitario San Vicente Fundación Rionegro, Rionegro, Antioquia, Colombia
| | - Adriana Giraldo-Villa
- Departamento de nutrición clínica, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
| | - Irene Acevedo-Castaño
- Departamento de nutrición y dietética, Hospital General, Medellín, Antioquia, Colombia
| | - Mónica A Yepes-Molina
- Departamento de nutrición y dietética, Hospital Universitario San Vicente Fundación Medellín, Medellín, Antioquia, Colombia
| | - Janeth Barbosa-Barbosa
- Departamento de nutrición, área de soporte nutricional, Clínica Las Américas, Medellín, Antioquia, Colombia
| | - Carlos J Barrera-Causil
- Research Group in Teaching and Modeling in Applied Exact Sciences, Instituto Tecnológico Metropolitano - ITM, Medellín, Antioquia, Colombia
| | - Gloria M Agudelo-Ochoa
- Food and Human Nutrition Research Group, Universidad de Antioquia - UdeA, Medellín, Antioquia, Colombia
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Tuchmann-Durand C, Thevenet E, Moulin F, Lesage F, Bouchereau J, Oualha M, Khraiche D, Brassier A, Wicker C, Gobin-Limballe S, Arnoux JB, Lacaille F, Wicart C, Coat B, Schlattler J, Cisternino S, Renolleau S, Secretan PH, De Lonlay P. Administration of gamma-hydroxybutyrate instead of beta-hydroxybutyrate to a liver transplant recipient suffering from propionic acidemia and cardiomyopathy: A case report on a medication prescribing error. JIMD Rep 2020; 51:25-29. [PMID: 32071836 PMCID: PMC7012734 DOI: 10.1002/jmd2.12090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
Beta‐hydroxybutyrate (BHB) is a synthetic ketone body used as an adjuvant energy substrate in the treatment of patients with metabolic cardiomyopathy. A medication prescribing error led to the administration of the general anesthetic sodium gamma‐hydroxybutyrate (GHB) instead of sodium BHB in a liver transplant recipient with propionic acidemia and cardiomyopathy, causing acute coma. A 15‐year‐old boy suffering from neonatal propionic acidemia underwent liver transplantation (LT) for metabolic decompensation and cardiomyopathy (treated with cardiotropic drugs and BHB) diagnosed a year previously. The patient had been rapidly extubated after LT, and was recovering well. Eight days after LT, the patient suddenly became comatose. No metabolic, immunological, hypertensive, or infectious complications were apparent. The brain magnetic resonance imaging and electroencephalography results were normal. The coma was soon attributed to a medication prescribing error: administration of GHB instead of BHB on day 8 post‐LT. The patient recovered fully within a few hours of GHB withdrawal. The computerized prescription system had automatically suggested the referenced anesthetic GHB (administered intravenously) instead of the non‐referenced ketone body BHB, triggering coma in our patient. A computerized prescription system generated a medication prescribing error for a rare disease, in which the general anesthetic GHB was mistaken for the nonreferenced energy substrate BHB.
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Affiliation(s)
- Caroline Tuchmann-Durand
- Imagine Institut des Maladies Génétiques, Paris, France and Biotherapy Department Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Eloise Thevenet
- Reference Center for Inherited Metabolic Diseases Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Florence Moulin
- Intensive Care Unit Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris and Paris Descartes University Paris France
| | - Fabrice Lesage
- Intensive Care Unit Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris and Paris Descartes University Paris France
| | - Juliette Bouchereau
- Reference Center for Inherited Metabolic Diseases Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Mehdi Oualha
- Intensive Care Unit Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris and Paris Descartes University Paris France
| | - Diala Khraiche
- Cardiology Care Unit Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Anaïs Brassier
- Reference Center for Inherited Metabolic Diseases Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Camille Wicker
- Reference Center for Inherited Metabolic Diseases Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Stéphanie Gobin-Limballe
- Molecular Genetic Department Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Jean-Baptiste Arnoux
- Reference Center for Inherited Metabolic Diseases Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Florence Lacaille
- Paediatric Hepatology Unit, Reference Center for Rare Pediatric Liver Diseases, Department of Gastroenterology-Hepatology-Nutrition Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, APHP, Filière Filfoie, ERN Transplantchild Paris France
| | - Clotilde Wicart
- Reference Center for Inherited Metabolic Diseases Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Bruno Coat
- Pharmacy's Department Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Joel Schlattler
- Pharmacy's Department Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Salvatore Cisternino
- Pharmacy's Department Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Sylvain Renolleau
- Intensive Care Unit Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris and Paris Descartes University Paris France
| | - Philippe-Henri Secretan
- Pharmacy's Department Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France
| | - Pascale De Lonlay
- Reference Center for Inherited Metabolic Diseases Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris Paris France.,Imagine Institut des Maladies Génétiques Filière G2M, MetabERN, INEM 1151, Paris Descartes University Paris France
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Barengolts E, Green SJ, Chlipala GE, Layden BT, Eisenberg Y, Priyadarshini M, Dugas LR. Predictors of Obesity among Gut Microbiota Biomarkers in African American Men with and without Diabetes. Microorganisms 2019; 7:microorganisms7090320. [PMID: 31491976 PMCID: PMC6780321 DOI: 10.3390/microorganisms7090320] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023] Open
Abstract
Gut microbiota and their biomarkers may be associated with obesity. This study evaluated associations of body mass index (BMI) with circulating microbiota biomarkers in African American men (AAM) (n = 75). The main outcomes included fecal microbial community structure (16S rRNA), gut permeability biomarkers (ELISA), and short-chain fatty acids (SCFAs, metabolome analysis). These outcomes were compared between obese and non-obese men, after adjusting for age. The results showed that lipopolysaccharide-binding protein (LBP), the ratio of LBP to CD14 (LBP/CD14), and SCFAs (propionic, butyric, isovaleric) were higher in obese (n = 41, age 58 years, BMI 36 kg/m2) versus non-obese (n = 34, age 55 years, BMI 26 kg/m2) men. BMI correlated positively with LBP, LBP/CD14 (p < 0.05 for both) and SCFAs (propionic, butyric, isovaleric, p < 0.01 for all). In the regression analysis, LBP, LBP/CD14, propionic and butyric acids were independent determinants of BMI. The study showed for the first time that selected microbiota biomarkers (LBP, LBP/CD14, propionic and butyric acids) together with several other relevant risks explained 39%–47% of BMI variability, emphasizing that factors other than microbiota-related biomarkers could be important. Further research is needed to provide clinical and mechanistic insight into microbiota biomarkers and their utility for diagnostic and therapeutic purposes.
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Affiliation(s)
- Elena Barengolts
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
- Section of Endocrinology, Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL 60612, USA.
| | - Stefan J Green
- Sequencing Core, Research Resources Center, University of Illinois, Chicago, IL 60612, USA
| | - George E Chlipala
- Research Informatics Core, Research Resources Center, University of Illinois, Chicago, IL 60612, USA
| | - Brian T Layden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
- Section of Endocrinology, Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Yuval Eisenberg
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Medha Priyadarshini
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Lara R Dugas
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA
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Abstract
The three essential branched-chain amino acids (BCAAs), leucine, isoleucine and valine, share the first enzymatic steps in their metabolic pathways, including a reversible transamination followed by an irreversible oxidative decarboxylation to coenzyme-A derivatives. The respective oxidative pathways subsequently diverge and at the final steps yield acetyl- and/or propionyl-CoA that enter the Krebs cycle. Many disorders in these pathways are diagnosed through expanded newborn screening by tandem mass spectrometry. Maple syrup urine disease (MSUD) is the only disorder of the group that is associated with elevated body fluid levels of the BCAAs. Due to the irreversible oxidative decarboxylation step distal enzymatic blocks in the pathways do not result in the accumulation of amino acids, but rather to CoA-activated small carboxylic acids identified by gas chromatography mass spectrometry analysis of urine and are therefore classified as organic acidurias. Disorders in these pathways can present with a neonatal onset severe-, or chronic intermittent- or progressive forms. Metabolic instability and increased morbidity and mortality are shared between inborn errors in the BCAA pathways, while treatment options remain limited, comprised mainly of dietary management and in some cases solid organ transplantation.
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Affiliation(s)
- I Manoli
- Organic Acid Research Section, Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, MD, USA
| | - C P Venditti
- Organic Acid Research Section, Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, MD, USA
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