Intensive Care Department and Burn Centre, University Hospital of Liège, University of Liège, 4000 Liège, Belgium.
Clinical Chemistry Department, University Hospital of Liège, University of Liège, 4000 Liège, Belgium.
Nutrients. 2022 Mar 7;14(5):1122. doi: 10.3390/nu14051122.
A stay in intensive care unit (ICU) exposes patients to a risk of carnitine deficiency. Moreover, acylated derivates of carnitine (acylcarnitines, AC) are biomarkers for metabolic mitochondrial dysfunction that have been linked to post-ICU disorders. This study aimed to describe the AC profile of survivors of a prolonged ICU stay (≥7 days). Survivors enrolled in our post-ICU clinic between September 2020 and July 2021 were included. Blood analysis was routinely performed during the days after ICU discharge, focusing on metabolic markers and including AC profile. Serum AC concentrations were determined by LC-MS/MS and were compared to the reference ranges (RR) established from serum samples of 50 non-hospitalized Belgian adults aged from 18 to 81 years. A total 162 patients (65.4% males, age 67 (58.7−73) years) survived an ICU stay of 9.7 (7.1−19.3) days and were evaluated 5 (3−8) days after discharge. Their AC profile was significantly different compared to RR, mostly in terms of short chain AC: the sum of C3, C4 and C5 derivates reached 1.36 (0.98−1.99) and 0.86 (0.66−0.99) µmol/L respectively (p < 0.001). Free carnitine (C0) concentration of survivors (46.06 (35.04−56.35) µmol/L) was similar to RR (43.64 (36.43−52.96) µmol/L) (p = 0.55). C0 below percentile 2.5 of RR was observed in 6/162 (3.7%) survivors. Their total AC/C0 ratio was 0.33 (0.22−0.42). A ratio above 0.4 was observed in 45/162 (27.8%) patients. In ICU survivors, carnitine deficiency was rare, but AC profile was altered and AC/C0 ratio was abnormal in more than 25%. The value of AC profile as a marker of post-ICU dysmetabolism needs further investigations.
入住重症监护病房（ICU）会使患者面临肉碱缺乏的风险。此外，肉碱的酰基衍生物（酰基肉碱，AC）是代谢线粒体功能障碍的生物标志物，与 ICU 后疾病有关。本研究旨在描述 ICU 住院时间延长（≥7 天）幸存者的 AC 谱。纳入 2020 年 9 月至 2021 年 7 月期间在 ICU 后诊所就诊的幸存者。在 ICU 出院后的几天内常规进行血液分析，重点关注代谢标志物，包括 AC 谱。通过 LC-MS/MS 测定血清 AC 浓度，并与 50 名非住院的比利时成年人（年龄 18-81 岁）的血清样本建立的参考范围（RR）进行比较。共有 162 名患者（65.4%为男性，年龄 67（58.7-73）岁）存活了 9.7（7.1-19.3）天的 ICU 住院时间，并在出院后 5（3-8）天进行了评估。他们的 AC 谱与 RR 相比有显著差异，主要是短链 AC：C3、C4 和 C5 衍生物的总和分别达到 1.36（0.98-1.99）和 0.86（0.66-0.99）µmol/L（p<0.001）。幸存者游离肉碱（C0）浓度（46.06（35.04-56.35）µmol/L）与 RR（43.64（36.43-52.96）µmol/L）相似（p=0.55）。在 6/162（3.7%）幸存者中观察到 C0 低于 RR 第 2.5 百分位数。他们的总 AC/C0 比值为 0.33（0.22-0.42）。45/162（27.8%）患者的比值大于 0.4。在 ICU 幸存者中，肉碱缺乏很少见，但 AC 谱改变，超过 25%的患者 AC/C0 比值异常。AC 谱作为 ICU 后代谢紊乱标志物的价值需要进一步研究。
