Plasma lipid profiling for the prognosis of 90-day mortality, in-hospital mortality, ICU admission, and severity in bacterial community-acquired pneumonia (CAP)
While one of the greatest health crises in a century is raging, the need for methods that could provide value in infectious disease research is apparent.
The recognition that metabolic processes and immune regulation are intimately related has resulted in increasing interest in immunometabolism. In fact, fewer than 100 publications in 2015 featured the term “immunometabolism”, compared to >500 in 2020. Biocrates is proud of its contribution to this research area, through projects such as the INITIATE project, which seeks to investigate immunometabolism in order to define novel antiviral targets.
Besides its demonstrated value in pharmaceutical and basic research, there is significant and likely underappreciated potential for metabolomics to advance clinical research on infectious diseases. While several aspects have been discussed in our series of articles on Covid-19, here, we take a closer look at a recent publication in the field of infectious diseases.
Banoei and colleagues sought to uncover prognostic signatures of mortality from patient plasma collected upon hospitalization for bacterial Community-Acquired Pneumonia (CAP). They further examined the ability of biomarkers to predict in-hospital mortality, ICU admission, and disease severity. The group employed biocrates’ kit technology, supplemented with complementary GC-MS and 1H-NMR technologies to further enrich the data set. The results detailed below are based on biocrates’ technology as it has been found to provide more informative data compared to the other technologies.
In this study, plasma from 75 patients who survived >90 days was compared to plasma from 75 patients who died in the same time span. Among the non-survivors, 26 included in-hospital fatalities. A group of 31 patients that were ICU-ventilated for different reasons than pneumonia was used as an independent control group. A signature of Lysophosphatidylcholines and Acylcarnitines was associated with CAP mortality. More specifically, decreased Lysophosphatidylcholines and Phosphatidylcholines, together with an increase in Acylcarnitines, was predictive of both ICU admission and subsequent in-hospital mortality. In addition, low tryptophan levels were associated with mortality, confirming earlier metabolomics studies on outcome in CAP (Meier et al., Clin Chem Lab Med 2016).
The significance of this study is highlighted by the poor predictive value of current clinical scoring systems. In addition, given that morbidity and mortality in viral pneumonia is often caused by bacterial superinfection, it is likely that these results could be translatable to viral pneumonia. In fact, similar metabolite alterations have been reported in COVID-19 patients. Finally, this publication sheds light on the importance and potential of nutritional support, especially regarding essential amino acids and fatty acid composition, in achieving optimum outcomes in CAP.
Further information about the INITIATE project can be found at https://cordis.europa.eu/project/id/813343.
More on metabolomics and COVID-19
Banoei MM, Vogel H J, Weljie AM, Yende S, Angus DC, Winston BW: Plasma lipid profiling for the prognosis of 90-day mortality, in-hospital mortality, ICU admission, and severity in bacterial community-acquired pneumonia (CAP) (2020). Critical care (London, England) | https://doi.org/10.1186/s13054-020-03147-3