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Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease

OBJECTIVE: Inflammation and metabolism are closely interlinked. Both undergo significant dysregulation following surgery for congenital heart disease, contributing to organ failure and morbidity. In this study, we combined cytokine and metabolic profiling to examine the effect of postoperative tight...

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Autores principales: Correia, Goncalo D. S., Wooi Ng, Keng, Wijeyesekera, Anisha, Gala-Peralta, Sandra, Williams, Rachel, MacCarthy-Morrogh, S., Jiménez, Beatriz, Inwald, David, Macrae, Duncan, Frost, Gary, Holmes, Elaine, Pathan, Nazima
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467581/
https://www.ncbi.nlm.nih.gov/pubmed/25844698
http://dx.doi.org/10.1097/CCM.0000000000000982
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author Correia, Goncalo D. S.
Wooi Ng, Keng
Wijeyesekera, Anisha
Gala-Peralta, Sandra
Williams, Rachel
MacCarthy-Morrogh, S.
Jiménez, Beatriz
Inwald, David
Macrae, Duncan
Frost, Gary
Holmes, Elaine
Pathan, Nazima
author_facet Correia, Goncalo D. S.
Wooi Ng, Keng
Wijeyesekera, Anisha
Gala-Peralta, Sandra
Williams, Rachel
MacCarthy-Morrogh, S.
Jiménez, Beatriz
Inwald, David
Macrae, Duncan
Frost, Gary
Holmes, Elaine
Pathan, Nazima
author_sort Correia, Goncalo D. S.
collection PubMed
description OBJECTIVE: Inflammation and metabolism are closely interlinked. Both undergo significant dysregulation following surgery for congenital heart disease, contributing to organ failure and morbidity. In this study, we combined cytokine and metabolic profiling to examine the effect of postoperative tight glycemic control compared with conventional blood glucose management on metabolic and inflammatory outcomes in children undergoing congenital heart surgery. The aim was to evaluate changes in key metabolites following congenital heart surgery and to examine the potential of metabolic profiling for stratifying patients in terms of expected clinical outcomes. DESIGN: Laboratory and clinical study. SETTING: University Hospital and Laboratory. PATIENTS: Of 28 children undergoing surgery for congenital heart disease, 15 underwent tight glycemic control postoperatively and 13 were treated conventionally. INTERVENTIONS: Metabolic profiling of blood plasma was undertaken using proton nuclear magnetic resonance spectroscopy. A panel of metabolites was measured using a curve-fitting algorithm. Inflammatory cytokines were measured by enzyme-linked immunosorbent assay. The data were assessed with respect to clinical markers of disease severity (Risk Adjusted Congenital heart surgery score-1, Pediatric Logistic Organ Dysfunction, inotrope score, duration of ventilation and pediatric ICU-free days). MEASUREMENTS AND MAIN RESULTS: Changes in metabolic and inflammatory profiles were seen over the time course from surgery to recovery, compared with the preoperative state. Tight glycemic control did not significantly alter the response profile. We identified eight metabolites (3-d-hydroxybutyrate, acetone, acetoacetate, citrate, lactate, creatine, creatinine, and alanine) associated with surgical and disease severity. The strength of proinflammatory response, particularly interleukin-8 and interleukin-6 concentrations, inversely correlated with PICU-free days at 28 days. The interleukin-6/interleukin-10 ratio directly correlated with plasma lactate. CONCLUSIONS: This is the first report on the metabolic response to cardiac surgery in children. Using nuclear magnetic resonance to monitor the patient journey, we identified metabolites whose concentrations and trajectory appeared to be associated with clinical outcome. Metabolic profiling could be useful for patient stratification and directing investigations of clinical interventions.
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spelling pubmed-44675812015-07-15 Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease Correia, Goncalo D. S. Wooi Ng, Keng Wijeyesekera, Anisha Gala-Peralta, Sandra Williams, Rachel MacCarthy-Morrogh, S. Jiménez, Beatriz Inwald, David Macrae, Duncan Frost, Gary Holmes, Elaine Pathan, Nazima Crit Care Med Pediatric Critical Care OBJECTIVE: Inflammation and metabolism are closely interlinked. Both undergo significant dysregulation following surgery for congenital heart disease, contributing to organ failure and morbidity. In this study, we combined cytokine and metabolic profiling to examine the effect of postoperative tight glycemic control compared with conventional blood glucose management on metabolic and inflammatory outcomes in children undergoing congenital heart surgery. The aim was to evaluate changes in key metabolites following congenital heart surgery and to examine the potential of metabolic profiling for stratifying patients in terms of expected clinical outcomes. DESIGN: Laboratory and clinical study. SETTING: University Hospital and Laboratory. PATIENTS: Of 28 children undergoing surgery for congenital heart disease, 15 underwent tight glycemic control postoperatively and 13 were treated conventionally. INTERVENTIONS: Metabolic profiling of blood plasma was undertaken using proton nuclear magnetic resonance spectroscopy. A panel of metabolites was measured using a curve-fitting algorithm. Inflammatory cytokines were measured by enzyme-linked immunosorbent assay. The data were assessed with respect to clinical markers of disease severity (Risk Adjusted Congenital heart surgery score-1, Pediatric Logistic Organ Dysfunction, inotrope score, duration of ventilation and pediatric ICU-free days). MEASUREMENTS AND MAIN RESULTS: Changes in metabolic and inflammatory profiles were seen over the time course from surgery to recovery, compared with the preoperative state. Tight glycemic control did not significantly alter the response profile. We identified eight metabolites (3-d-hydroxybutyrate, acetone, acetoacetate, citrate, lactate, creatine, creatinine, and alanine) associated with surgical and disease severity. The strength of proinflammatory response, particularly interleukin-8 and interleukin-6 concentrations, inversely correlated with PICU-free days at 28 days. The interleukin-6/interleukin-10 ratio directly correlated with plasma lactate. CONCLUSIONS: This is the first report on the metabolic response to cardiac surgery in children. Using nuclear magnetic resonance to monitor the patient journey, we identified metabolites whose concentrations and trajectory appeared to be associated with clinical outcome. Metabolic profiling could be useful for patient stratification and directing investigations of clinical interventions. Lippincott Williams & Wilkins 2015-07 2015-06-16 /pmc/articles/PMC4467581/ /pubmed/25844698 http://dx.doi.org/10.1097/CCM.0000000000000982 Text en Copyright © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Pediatric Critical Care
Correia, Goncalo D. S.
Wooi Ng, Keng
Wijeyesekera, Anisha
Gala-Peralta, Sandra
Williams, Rachel
MacCarthy-Morrogh, S.
Jiménez, Beatriz
Inwald, David
Macrae, Duncan
Frost, Gary
Holmes, Elaine
Pathan, Nazima
Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease
title Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease
title_full Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease
title_fullStr Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease
title_full_unstemmed Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease
title_short Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease
title_sort metabolic profiling of children undergoing surgery for congenital heart disease
topic Pediatric Critical Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467581/
https://www.ncbi.nlm.nih.gov/pubmed/25844698
http://dx.doi.org/10.1097/CCM.0000000000000982
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