Metabolites are generated from critical biological functions and metabolism. This pediatric study reviewed plasma metabolites in patients suffering from multi-organ dysfunction syndrome (MODS) in the pediatric intensive care unit (PICU) using an untargeted metabolomics approach.

Patients meeting criteria for MODS were screened for eligibility and consented (n=24), and blood samples were collected at baseline, 72 hours, and 8 days; control patients (n=4), were presenting for routine sedation in an outpatient setting.

A sub-set of MODS patients (n=8) required additional support with veno-atrial extracorporeal membrane oxygenation (VA-ECMO) therapy.

Metabolites from thawed blood plasma were determined from ion pairing reversed-phase LC-MS analysis.

Chromatographic peak alignment, identification, relative quantitation, statistical and bioinformatics evaluation were performed using MAVEN and MetaboAnalyst 4.0.

Metabolite analysis revealed 115 peaks per sample.

From the PLS-DA with VIP scores above [≥]2.0, 7 dynamic metabolites emerged over the 3 time points: tauro-chenodeoxycholic acid (TCDCA), hexose, p-hydroxybenzoate, hydroxyphenylacetic acid (HPLA), 2_3-dihydroxybenzoic acid, 2-keto-isovalerate, and deoxyribose phosphate.

After Bonferonni adjustment for repeated measures hexose and p-hydroxybenzoate were significant at one time point, or more.

Kendalls tau-b test was used for internal validation of creatinine. Metabolites may be benign or significant in describing a patients pathophysiology and require operator interpretation.

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