Disruption of the circadian rhythm of melatonin: A biomarker of critical illness severity.

Autor: Melone MA; Department of Pulmonary, Thoracic Oncology and Respiratory Intensive Care, Rouen University Hospital, Univ Rouen, F-76000, Rouen, France; CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, F-76821, Mont-Saint-Aignan, France. Electronic address: marieanne.melone@chu-rouen.fr., Becker TC; Department of Internal Medicine, University of Iowa, Iowa City, IA, USA., Wendt LH; Institute of Clinical and Translational Science, University of Iowa, Iowa City, IA, USA., Ten Eyck P; Institute of Clinical and Translational Science, University of Iowa, Iowa City, IA, USA., Patel SB; Department of Internal Medicine, Loyola University of Chicago, Chicago, IL, USA., Poston J; Department of Medicine, University of Chicago, Chicago, IL, USA., Pohlman AS; Department of Medicine, University of Chicago, Chicago, IL, USA., Pohlman M; New England Sleep Center, Manchester, NH, USA., Miller A; Department of Medicine, University of Chicago, Chicago, IL, USA., Nedeltcheva A; Cook County Health and Hospitals System, Chicago, IL, USA., Hall JB; Department of Medicine, University of Chicago, Chicago, IL, USA., Van Cauter E; Department of Medicine, University of Chicago, Chicago, IL, USA., Zabner J; Department of Internal Medicine, University of Iowa, Iowa City, IA, USA., Gehlbach BK; Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; Department of Neurology, University of Iowa, Iowa City, IA, USA.
Jazyk: angličtina
Zdroj: Sleep medicine [Sleep Med] 2023 Oct; Vol. 110, pp. 60-67. Date of Electronic Publication: 2023 Jul 28.
DOI: 10.1016/j.sleep.2023.07.033
Abstrakt: Circadian dysrhythmias occur commonly in critically ill patients reflecting variable effects of underlying illness, ICU environment, and treatments. We retrospectively analyzed the relationship between clinical outcomes and 24-h urinary 6-sulfatoxymelatonin (aMT6s) excretion profiles in 37 critically ill patients with shock and/or respiratory failure. Nonlinear regression was used to fit a 24-h cosine curve to each patient's aMT6s profile, with rhythmicity determined by the zero-amplitude test. From these curves we determined acrophase, amplitude, phase, and night/day ratio. After assessing unadjusted relationships, we identified the optimal multivariate models for hospital survival and for discharge to home (vs. death or transfer to another facility). Normalized aMT6s rhythm amplitude was greater (p = 0.005) in patients discharged home than in those who were not, while both groups exhibited a phase delay. Patients with rhythmic aMT6s excretion were more likely to survive (OR 5.25) and be discharged home (OR 8.89; p < 0.05 for both) than patients with arrhythmic profiles, associations that persisted in multivariate modelling. In critically ill patients with shock and/or respiratory failure, arrhythmic and/or low amplitude 24-h aMT6s rhythms were associated with worse clinical outcomes, suggesting a role for the melatonin-based rhythm as a novel biomarker of critical illness severity.
Competing Interests: Declaration of competing interest Authors declare none.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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