Metabolic Profiling in Patients with Pneumonia on Intensive Care.
Metabolic Profiling in Patients with Pneumonia on Intensive Care.
复制标题
重症监护肺炎患者的代谢特征。
DOI：
10.1016/j.ebiom.2017.03.034
复制
发表时间：
2017-04
期刊：
影响因子：
11.1
通讯作者：
Gordon AC
中科院分区：
文献类型：
--
作者：
Antcliffe D;Jiménez B;Veselkov K;Holmes E;Gordon AC
Clinical features and investigations lack predictive value when diagnosing pneumonia, especially when patients are ventilated and when patients develop ventilator associated pneumonia (VAP). New tools to aid diagnosis are important to improve outcomes. This pilot study examines the potential for metabolic profiling to aid the diagnosis in critical care. In this prospective observational study ventilated patients with brain injuries or pneumonia were recruited in the intensive care unit and serum samples were collected soon after the start of ventilation. Metabolic profiles were produced using 1D 1H NMR spectra. Metabolic data were compared using multivariate statistical techniques including Principal Component Analysis (PCA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA). We recruited 15 patients with pneumonia and 26 with brain injuries, seven of whom went on to develop VAP. Comparison of metabolic profiles using OPLS-DA differentiated those with pneumonia from those with brain injuries (R2Y = 0.91, Q2Y = 0.28, p = 0.02) and those with VAP from those without (R2Y = 0.94, Q2Y = 0.27, p = 0.05). Metabolites that differentiated patients with pneumonia included lipid species, amino acids and glycoproteins. Metabolic profiling shows promise to aid in the diagnosis of pneumonia in ventilated patients and may allow a more timely diagnosis and better use of antibiotics. Metabolic profiling of serum from ventilated patients shows potential to aid in the diagnosis of pneumonia and ventilator associated pneumonia. Lipid species were particularly important in the discrimination of pneumonia and ventilator associated pneumonia from those with brain injuries. Metabolites including glycoproteins, amino acids and phospholipids also aided in discrimination. Pneumonia is a common problem in patients requiring breathing support in Intensive Care Units (ICU). When pneumonia develops patients take longer to get back to full health and in some cases may die. Current diagnostic tests are not always helpful. We measured an array of molecules, metabolites, in the blood of patients in ICU to compare those with pneumonia to those with brain injuries. We found that substances including lipids, amino acids and glycoproteins showed some ability to differentiate patients with pneumonia from other critically unwell patients. This technique, used with clinical data, may help improve the diagnosis of pneumonia.
