Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients

Journal of Intensive Care

Shing-Jong Lin¹  Shen-Chih Wang²  Ru-Yu Lien³  Shu-Fen Lu³  Ya-Wen Lu⁴  Yi-Lin Tsai⁴  Jiun-Yu Guo⁴  Po-Hsun Huang⁴  Cheng-Hsueh Wu⁴  Ming-Ren Kuo⁴  Ruey-Hsing Chou⁴  Po-Shan Wu⁵  Ruey-Yi Chou⁶ 

[1] Cardiovascular Research Center, National Yang Ming Chiao Tung University;Department of Anesthesiology, Taipei Veterans General Hospital;Department of Nursing, Taipei Veterans General Hospital;Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;Division of Clinical Nutrition, Department of Dietetics and Nutrition, Taipei Veterans General Hospital;Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital;

关键词: Trimethylamine N-oxide;    Gut microbiota;    Sepsis;    Nutrition;    Inflammation;   

DOI  :  10.1186/s40560-021-00581-5

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown