Metabolomic Analysis in Neurocritical Care Patients

Abstract

Metabolomics is the analytical study of metabolites in biological matrices using high-throughput profiling. Traditionally, the metabolome has been studied to identify various biomarkers for the diagnosis and pathophysiology of disease. Over the last decade, metabolomic research has grown to include the identification of prognostic markers, the development of novel treatment strategies, and the prediction of disease severity. In this review, we summarized the available evidence on the use of metabolome profiling in neurocritical care populations. Specifically, we focused on aneurysmal subarachnoid hemorrhage, traumatic brain injury, and intracranial hemorrhage to identify the gaps in the current literature and to provide direction for future studies. A primary literature search of the Medline and EMBASE databases was conducted. Upon removing duplicate studies, abstract screening and full-text screening were performed. We screened 648 studies and extracted data from 17 studies. Based on the current evidence, the utility of metabolomic profiling has been limited due to inconsistencies amongst studies and a lack of reproducible data. Studies identified various biomarkers for diagnosis, prognosis, and treatment modification. However, studies evaluated and identified different metabolites, resulting in an inability to compare the study results. Future research towards addressing the gaps in the current literature, including reproducing data on the use of specific metabolite panels, is needed.

Predicting Critically Ill Patients Outcome in the ICU using UHPLC-HRMS Data

“…N-acetyl-β-neuraminate levels have been associated with chronic kidney disease severity, endstage kidney disease, increased heart failure risk, and adverse outcomes in heart failure patients [19], [20]. Considering homovanillate, while reduced levels have been reported in patients with traumatic brain injury [21], other studies have described elevated levels of this metabolite in non-survivor patients. Examples include critically ill children experiencing complicated severe malnutrition [22], as well as acute critical ill patients diagnosed with nosocomial pneumonia [23] and septic shock [24].…”

Mecanismos de estabilização do paciente neurocrítico

“…A pressão intracraniana (PIC) é uma das principais preocupações em relação ao neuro crítico na unidade de terapia intensiva (UTI), segundo um estudo realizado por Yang et al (2022), foi confirmado que a hipertensão intracraniana (definida como valores de PIC superiores a 20 -25 mmHg) é considerada patologicamente relevante devido à sua relação com a mortalidade (Kharouba et al, 2023) De acordo com um estudo efetuado por Hawryluk et al (2019), bloqueadores neuromusculares (BNMs) também mostraram eficácia para redução da HIC, tendo em vista que esses interceptam a transmissão do impulso nervoso, consequentemente, inibindo os movimentos do paciente neuro crítico, pois a movimentação desse enfermo aumenta a PIC, assim como os sedativos (Midazolan, Propofol e Dexmetomidina) que visam a manutenção da hemodinâmica neuronal (BAUERSCHMIDT et al, 2023). Porém, ressaltam precauções para o uso desses fármacos, destaca-se, portanto, que a utilização precoce, rotineira e prolongada dessas substâncias em pacientes neuro críticos é prejudicial.…”

Metabolomics, the future of biomarkers?

“…To date, metabolomics studies have already proved their value in the development of new diagnostic and prognostic tools, and have also improved our understanding of pathophysiology and, consequently, patient management in pathologies of interest to the emergency care domain. For example, metabolomics allowed the identification of new prognostic biomarkers in traumatic brain injury patients that may serve as indicators for optimizing management [4]. Experimental data also showed promise in identifying the various phenomena leading to acute renal failure [5].…”