Serum Levels of Branched Chain Amino Acids Predict Duration of Cardiovascular Organ Failure in Septic Shock
| Autor: | Alan E. Jones, Thomas L. Flott, Alla Karnovsky, Race Trial Investigators, Michael A. Puskarich, Kathleen A. Stringer, Cora McHugh |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Organ Dysfunction Scores Multiple Organ Failure 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Gastroenterology Article law.invention Sepsis 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Valine Predictive Value of Tests Internal medicine medicine Humans Aged business.industry Septic shock Confounding 030208 emergency & critical care medicine Middle Aged medicine.disease Prognosis Shock Septic Pathophysiology Cardiovascular Diseases Shock (circulatory) Emergency Medicine SOFA score Female medicine.symptom business Amino Acids Branched-Chain |
| Zdroj: | Shock |
| Popis: | Background Sepsis shifts cardiac metabolic fuel preference and this disruption may have implications for cardiovascular function. A greater understanding of the role of metabolism in the development and persistence of cardiovascular failure in sepsis could serve to identify novel pharmacotherapeutic approaches. Methods Secondary analysis of prospective quantitative proton nuclear magnetic resonance (1H-NMR) metabolomic data from patients enrolled in a phase II randomized control trial of L-carnitine in septic shock. Participants with a sequential organ failure assessment (SOFA) score of > = 5, lactate > = 2, and requiring vasopressor support for at least 4 h were eligible for enrollment. The independent prognostic value of metabolites to predict survival with shock resolution within 48 h and vasopressor free days were assessed. Concentrations of predictive metabolites were compared between participants with and without shock resolution at 48 h. Results Serum 1H-NMR metabolomics data from 228 patients were analyzed. Eighty-one (36%) patients met the primary outcome; 33 (14%) died prior to 48 h. The branched chain amino acids (BCAA), valine, leucine, and isoleucine were univariate predictors of the primary outcome after adjusting for multiple hypothesis testing, while valine remained significant after controlling for SOFA score. Similar results were observed when analyzed based on vasopressor free days, and persisted after controlling for confounding variables and excluding non-survivors. BCAA concentrations at 48 h significantly discriminated between those with shock resolution versus persistent shock. Conclusions Among patients with septic shock, BCAA concentrations independently predict time to shock resolution. This study provides hypothesis generating data into the potential contribution of BCAAs to the pathophysiology of cardiovascular failure in sepsis, opening areas for future investigations. |
| Databáze: | OpenAIRE |
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