title: 1H NMR global metabolic phenotyping of acute pancreatitis in the emergency unit.
abstract: We have investigated the urinary and plasma metabolic phenotype of acute pancreatitis (AP) patients presenting to the emergency room at a single center London teaching hospital with acute abdominal pain using (1)H NMR spectroscopy and multivariate modeling. Patients were allocated to either the AP (n = 15) or non-AP patients group (all other causes of abdominal pain, n = 21) on the basis of the national guidelines. Patients were assessed for three clinical outcomes: (1) diagnosis of AP, (2) etiology of AP caused by alcohol consumption and cholelithiasis, and (3) AP severity based on the Glasgow score. Samples from AP patients were characterized by high levels of urinary ketone bodies, glucose, plasma choline and lipid, and relatively low levels of urinary hippurate, creatine and plasma-branched chain amino acids. AP could be reliably identified with a high degree of sensitivity and specificity (OPLS-DA model R(2) = 0.76 and Q(2)Y = 0.59) using panel of discriminatory biomarkers consisting of guanine, hippurate and creatine (urine), and valine, alanine and lipoproteins (plasma). Metabolic phenotyping was also able to distinguish between cholelithiasis and colonic inflammation among the heterogeneous non-AP group. This work has demonstrated that combinatorial biomarkers have a strong diagnostic and prognostic potential in AP with relevance to clinical decision making in the emergency unit.
authors.affiliation: Section of Biomolecular Medicine, Division of Computational and Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London , Sir Alexander Fleming Building, Exhibition Road, South Kensington, London SW7 2AZ, United Kingdom.
authors.forename: Alma
authors.initials: A
authors.lastname: Villaseñor
authors.forename: James M
authors.initials: JM
authors.lastname: Kinross
authors.forename: Jia V
authors.initials: JV
authors.lastname: Li
authors.forename: Nicholas
authors.initials: N
authors.lastname: Penney
authors.forename: Richard H
authors.initials: RH
authors.lastname: Barton
authors.forename: Jeremy K
authors.initials: JK
authors.lastname: Nicholson
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Coral
authors.initials: C
authors.lastname: Barbas
authors.forename: Elaine
authors.initials: E
authors.lastname: Holmes
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D000596:Amino Acids / Q000097:blood / Q000737:chemistry; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002769:Cholelithiasis / Q000150:complications; D003401:Creatine / Q000652:urine; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007657:Ketone Bodies / Q000652:urine; D008055:Lipids / Q000097:blood; D008297:Male; D055442:Metabolome; D055432:Metabolomics / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D011379:Prognosis; D066244:Proton Magnetic Resonance Spectroscopy / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000596:Amino Acids; D015415:Biomarkers; D007657:Ketone Bodies; D008055:Lipids; D003401:Creatine
keywords: NMR; abdominal pain; acute pancreatitis; metabonomics; patient stratification