Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients
Abstract Background Trimethylamine N-oxide (TMAO) is a microbiota-derived metabolite, which is linked to vascular inflammation and atherosclerosis in cardiovascular (CV) diseases. But its effect in infectious diseases remains unclear. We conducted a single-center prospective study to investigate ass...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40560-021-00581-5 |
| _version_ | 1819030631814791168 |
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| author | Ruey-Hsing Chou Po-Shan Wu Shen-Chih Wang Cheng-Hsueh Wu Shu-Fen Lu Ru-Yu Lien Yi-Lin Tsai Ya-Wen Lu Ming-Ren Kuo Jiun-Yu Guo Ruey-Yi Chou Po-Hsun Huang Shing-Jong Lin |
| author_facet | Ruey-Hsing Chou Po-Shan Wu Shen-Chih Wang Cheng-Hsueh Wu Shu-Fen Lu Ru-Yu Lien Yi-Lin Tsai Ya-Wen Lu Ming-Ren Kuo Jiun-Yu Guo Ruey-Yi Chou Po-Hsun Huang Shing-Jong Lin |
| author_sort | Ruey-Hsing Chou |
| collection | DOAJ |
| description | Abstract Background Trimethylamine N-oxide (TMAO) is a microbiota-derived metabolite, which is linked to vascular inflammation and atherosclerosis in cardiovascular (CV) diseases. But its effect in infectious diseases remains unclear. We conducted a single-center prospective study to investigate association of TMAO with in-hospital mortality in septic patients admitted to an intensive care unit (ICU). Methods Totally 95 septic, mechanically ventilated patients were enrolled. Blood samples were obtained within 24 h after ICU admission, and plasma TMAO concentrations were determined. Septic patients were grouped into tertiles according to TMAO concentration. The primary outcome was in-hospital death, which further classified as CV and non-CV death. Besides, we also compared the TMAO concentrations of septic patients with 129 non-septic patients who were admitted for elective coronary angiography (CAG). Results Septic patients had significantly lower plasma TMAO levels than did subjects admitted for CAG (1.0 vs. 3.0 μmol/L, p < 0.001). Septic patients in the lowest TMAO tertile (< 0.4 μmol/L) had poorer nutrition status and were given longer antibiotic courses before ICU admission. Circulating TMAO levels correlated positively with daily energy intake, the albumin and prealbumin concentration. Compared with those in the highest TMAO tertile, septic patients in the lowest TMAO tertile were at greater risk of non-CV death (hazard ratio 2.51, 95% confidence interval 1.21–5.24, p = 0.014). However, TMAO concentration was no longer an independent predictor for non-CV death after adjustment for disease severity and nutritional status. Conclusion Plasma TMAO concentration was inversely associated with non-CV death among extremely ill septic patients, which could be characterized as TMAO paradox. For septic patients, the impact of malnutrition reflected by circulating TMAO levels was greater than its pro-inflammatory nature. |
| first_indexed | 2024-12-21T06:33:14Z |
| format | Article |
| id | doaj.art-c4544ed6cd294c979b378af2161d5055 |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-12-21T06:33:14Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-c4544ed6cd294c979b378af2161d50552022-12-21T19:12:57ZengBMCJournal of Intensive Care2052-04922021-10-019111210.1186/s40560-021-00581-5Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patientsRuey-Hsing Chou0Po-Shan Wu1Shen-Chih Wang2Cheng-Hsueh Wu3Shu-Fen Lu4Ru-Yu Lien5Yi-Lin Tsai6Ya-Wen Lu7Ming-Ren Kuo8Jiun-Yu Guo9Ruey-Yi Chou10Po-Hsun Huang11Shing-Jong Lin12Division of Cardiology, Department of Medicine, Taipei Veterans General HospitalDivision of Clinical Nutrition, Department of Dietetics and Nutrition, Taipei Veterans General HospitalDepartment of Anesthesiology, Taipei Veterans General HospitalDivision of Cardiology, Department of Medicine, Taipei Veterans General HospitalDepartment of Nursing, Taipei Veterans General HospitalDepartment of Nursing, Taipei Veterans General HospitalDivision of Cardiology, Department of Medicine, Taipei Veterans General HospitalDivision of Cardiology, Department of Medicine, Taipei Veterans General HospitalDivision of Cardiology, Department of Medicine, Taipei Veterans General HospitalDivision of Cardiology, Department of Medicine, Taipei Veterans General HospitalDivision of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General HospitalDivision of Cardiology, Department of Medicine, Taipei Veterans General HospitalCardiovascular Research Center, National Yang Ming Chiao Tung UniversityAbstract Background Trimethylamine N-oxide (TMAO) is a microbiota-derived metabolite, which is linked to vascular inflammation and atherosclerosis in cardiovascular (CV) diseases. But its effect in infectious diseases remains unclear. We conducted a single-center prospective study to investigate association of TMAO with in-hospital mortality in septic patients admitted to an intensive care unit (ICU). Methods Totally 95 septic, mechanically ventilated patients were enrolled. Blood samples were obtained within 24 h after ICU admission, and plasma TMAO concentrations were determined. Septic patients were grouped into tertiles according to TMAO concentration. The primary outcome was in-hospital death, which further classified as CV and non-CV death. Besides, we also compared the TMAO concentrations of septic patients with 129 non-septic patients who were admitted for elective coronary angiography (CAG). Results Septic patients had significantly lower plasma TMAO levels than did subjects admitted for CAG (1.0 vs. 3.0 μmol/L, p < 0.001). Septic patients in the lowest TMAO tertile (< 0.4 μmol/L) had poorer nutrition status and were given longer antibiotic courses before ICU admission. Circulating TMAO levels correlated positively with daily energy intake, the albumin and prealbumin concentration. Compared with those in the highest TMAO tertile, septic patients in the lowest TMAO tertile were at greater risk of non-CV death (hazard ratio 2.51, 95% confidence interval 1.21–5.24, p = 0.014). However, TMAO concentration was no longer an independent predictor for non-CV death after adjustment for disease severity and nutritional status. Conclusion Plasma TMAO concentration was inversely associated with non-CV death among extremely ill septic patients, which could be characterized as TMAO paradox. For septic patients, the impact of malnutrition reflected by circulating TMAO levels was greater than its pro-inflammatory nature.https://doi.org/10.1186/s40560-021-00581-5Trimethylamine N-oxideGut microbiotaSepsisNutritionInflammation |
| spellingShingle | Ruey-Hsing Chou Po-Shan Wu Shen-Chih Wang Cheng-Hsueh Wu Shu-Fen Lu Ru-Yu Lien Yi-Lin Tsai Ya-Wen Lu Ming-Ren Kuo Jiun-Yu Guo Ruey-Yi Chou Po-Hsun Huang Shing-Jong Lin Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients Journal of Intensive Care Trimethylamine N-oxide Gut microbiota Sepsis Nutrition Inflammation |
| title | Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients |
| title_full | Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients |
| title_fullStr | Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients |
| title_full_unstemmed | Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients |
| title_short | Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients |
| title_sort | paradox of trimethylamine n oxide the impact of malnutrition on microbiota derived metabolites and septic patients |
| topic | Trimethylamine N-oxide Gut microbiota Sepsis Nutrition Inflammation |
| url | https://doi.org/10.1186/s40560-021-00581-5 |
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