title: 1H-NMR-based metabolic signatures of clinical outcomes in trauma patients--beyond lactate and base deficit.
abstract: The determination of reliable biomarkers capable to predict clinical outcome of a trauma patient remains essential toward better therapeutic management of the patient in the intensive care unit. Assessment of global metabolic profiling using quantitative nuclear magnetic resonance (NMR)-based metabolomics offers an attractive modern methodology for fast and comprehensive determination of multiple circulating metabolites and for establishing metabolic phenotype of survivors versus nonsurvivors. Multivariate data analysis on 43 quantitative metabolic parameters identified three lipid metabolites, triacylglycerol, glycerol heads of phospholipids, and monounsaturated fatty acids, as being the most discriminative markers to separate survivors versus nonsurvivors at the time of admission. Glucose and glutamate were intermediate predictors, followed by lactate and hydroxybutyrate as two low-weight predictors. Ultimately, cellular and subcellular failure in nonsurviving trauma patients results in multiple systemic biochemical effects and in changes in circulating metabolites in the blood that are characteristic for decreased lipid synthesis and urea cycle activity in the liver, and for increased hyperglycemia, lactic, and ketoacidosis.
authors.affiliation: Department of Surgery, University of California, San Francisco, California, USA. mcohen@sfghsurg.ucsf.edu
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Cohen
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Serkova
authors.forename: Jeanine
authors.initials: J
authors.lastname: Wiener-Kronish
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Pittet
authors.forename: Claus U
authors.initials: CU
authors.lastname: Niemann
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D001786:Blood Glucose / Q000032:analysis; D005229:Fatty Acids, Monounsaturated / Q000097:blood; D005260:Female; D018698:Glutamic Acid / Q000097:blood; D006801:Humans; D006859:Hydrogen; D006885:Hydroxybutyrates / Q000097:blood; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D010743:Phospholipids / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood; D014947:Wounds and Injuries / Q000097:blood* / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D005229:Fatty Acids, Monounsaturated; D006885:Hydroxybutyrates; D010743:Phospholipids; D014280:Triglycerides; D019344:Lactic Acid; D018698:Glutamic Acid; D006859:Hydrogen