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Gundogan K, Nellis MM, Ozer NT, Ergul SS, Sahin GG, Temel S, Yuksel RC, Teeny S, Alvarez JA, Sungur M, Jones DP, Ziegler TR. High-Resolution Plasma Metabolomics and Thiamine Status in Critically Ill Adult Patients. Res Sq 2023:rs.3.rs-3597052. [PMID: 38014088 PMCID: PMC10680934 DOI: 10.21203/rs.3.rs-3597052/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIM Thiamine (Vitamin B1) is an essential micronutrient and a co-factor for metabolic functions related to energy metabolism. We determined the association between whole blood thiamine pyrophosphate (TPP) concentrations and plasma metabolites using high resolution metabolomics in critically ill patients. Methods Cross-sectional study performed in Erciyes University Hospital, Kayseri, Turkey and Emory University, Atlanta, GA, USA. Participants were ≥ 18 years of age, with an expected length of ICU stay longer than 48 hours, receiving furosemide therapy for at least 6 months before ICU admission. Results Blood for TPP and metabolomics was obtained on the day of ICU admission. Whole blood TPP concentrations were measured using high-performance liquid chromatography (HPLC). Liquid chromatography/mass spectrometry was used for plasma high-resolution metabolomics. Data was analyzed using regression analysis of TPP levels against all plasma metabolomic features in metabolome-wide association studies. We also compared metabolomic features from patients in the highest TPP concentration tertile to patients in the lowest TPP tertile as a secondary analysis. We enrolled 76 participants with a median age of 69 (range, 62.5-79.5) years. Specific metabolic pathways associated with whole blood TPP levels, using both regression and tertile analysis, included pentose phosphate, fructose and mannose, branched chain amino acid, arginine and proline, linoleate, and butanoate pathways. Conclusions Plasma high-resolution metabolomics analysis showed that whole blood TPP concentrations are significantly associated with metabolites and metabolic pathways linked to the metabolism of energy, amino acids, lipids, and the gut microbiome in adult critically ill patients.
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Gundogan K, Sahin GG, Ergul SS, Ozer NT, Temel S, Akbas T, Ercan T, Yildiz H, Dizdar OS, Simsek Z, Aydın K, Ulu R, Zerman A, Dal HC, Aydin E, Ozyilmaz E, Ateş N, Gonderen K, Yalcin N, Topeli A, Tok G, Edipoglu O, Ergan B, Aydemir FD, Akbudak IH, Ergun R, Yuksel RC, Sungur M, Griffith DP, Ziegler TR. Evaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study. J Crit Care 2023; 77:154326. [PMID: 37186999 DOI: 10.1016/j.jcrc.2023.154326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND/OBJECTIVES Thiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations. SUBJECTS/METHODS This observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. RESULTS A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all). CONCLUSIONS Our results show that 18% of these critically ill patients exhibited low whole blood TPP concentrations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.
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Affiliation(s)
- Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye.
| | - Gulsah G Sahin
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Serap S Ergul
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Nurhayat T Ozer
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Sahin Temel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye
| | - Turkay Akbas
- Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye
| | - Talha Ercan
- Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye
| | - Hamit Yildiz
- Department of Internal Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkiye
| | - Oguzhan S Dizdar
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Zuhal Simsek
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Kaniye Aydın
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Ramazan Ulu
- Department of Nephrology, Firat Medical Faculty, Elazig, Turkiye
| | - Avsar Zerman
- Department of Intensive Care Unit, Kirsehir Ahi Evran University, Kirsehir, Turkiye
| | - Hayriye C Dal
- Department of Intensive Care Unit, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkiye
| | - Emre Aydin
- Department of Nephrology, School of Medicine, Dicle University, Diyarbakır, Turkiye
| | - Ezgi Ozyilmaz
- Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye
| | - Nazire Ateş
- Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye
| | - Kamil Gonderen
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye
| | - Nazif Yalcin
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Gulay Tok
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Ozlem Edipoglu
- Department of Intensive Care Unit, Health Sciences University, İzmir Dr.Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkiye
| | - Begum Ergan
- Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkiye
| | - Ferhan D Aydemir
- Division of Intensive Care Medicine, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkiye
| | - Ismail H Akbudak
- Division of Intensive Care Medicine, Department of Internal Medicine, Pamukkale University School of Medicine, Denizli, Turkiye
| | - Recai Ergun
- Department of Chest Diseases, Selçuk University Faculty of Medicine, Konya, Turkiye
| | - Recep C Yuksel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye
| | - Murat Sungur
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Daniel P Griffith
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Gundogan K, Yucesoy FS, Ozer NT, Temel S, Sahin S, Sahin GG, Sungur M, Esmaoglu A, Talih T, Yazici C, Griffith DP, Ziegler TR. Serum Micronutrient Levels in Critically III Patients Receiving Continuous Renal Replacement Therapy: A Prospective, Observational Study. JPEN J Parenter Enteral Nutr 2022; 46:1141-1148. [PMID: 35383966 DOI: 10.1002/jpen.2378] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/04/2022] [Accepted: 03/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) may deplete micronutrient levels. Patients are also at risk for micronutrient depletion due to underlying illness(s), poor nutrient intake prior to intensive care unit (ICU) admission and/or increased requirements. We determined vitamin and trace element status before, during and after CRRT in critically ill patients. METHODS This prospective observational study performed in mixed medical and surgical ICU patients. Serial serum vitamin B6 and vitamin C concentrations were measured by HPLC and folic acid by ECLIA. Serum chromium, copper, selenium, and zinc were measured using ICP-MS. Serum ceruloplasmin was measured by the Erel method. RESULTS Fifty adult ICU patients with AKI were recruited. The median APACHE II score on ICU admission was high at 24.0 (6.0-33.0). The median days on CRRT was 2.0 (2.0-4.0) days. At baseline (within 10-15 minutes of CRRT initiation), serum vitamin C, selenium and zinc were below normal. Serum vitamin B6 levels at 72 hours on CRRT were significantly lower than at 24 hours (p=0.011). Serum vitamin C values fell significantly at 24 and 72 hours during CRRT (p=0.030 and p=0.001), respectively, and remained low 24 and 48 hours after CRRT was stopped (p=0.021). At baseline and during CRRT, 96% of participants had at least two or more micronutrient levels below the normal range. CONCLUSION Serum vitamin C, selenium and zinc concentrations were below the normal range at baseline. CRRT was associated with a significant further decrease in levels of vitamin C, selenium and zinc. CLINICAL RELEVANCY STATEMENT Critically ill patients who were experienced CRRT had serum vitamin C, selenium and zinc below the normal range during and after CRRT. Also, 96% of participants had at least two or more micronutrient levels below normal at baseline and during CRRT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kursat Gundogan
- Department of Internal Medicine, Division of Intensive Care, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Faruk S Yucesoy
- Department of Anesthesiology and Reanimation, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Nurhayat T Ozer
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Sahin Temel
- Department of Internal Medicine, Division of Intensive Care, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Serap Sahin
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Gulsah G Sahin
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Murat Sungur
- Department of Internal Medicine, Division of Intensive Care, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Aliye Esmaoglu
- Department of Anesthesiology and Reanimation, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Tutkun Talih
- Department of General Surgery, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Cevat Yazici
- Department of Clinical Biochemistry, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Daniel P Griffith
- Department of Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA.,Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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