Department of Anaesthesiology, University of Göttingen Medical Center, Göttingen, Germany.
Institute of Clinical Chemistry and Laboratory Medicine of the University Hospital Jena, Jena, Germany.
Clin Chem Lab Med. 2022 Mar 21;60(6):891-900. doi: 10.1515/cclm-2021-1176. Print 2022 May 25.
Cholestasis and elevated serum bile acid levels are common in critically ill patients. This study aims to define the specific pattern of bile acids associated with acute respiratory distress syndrome (ARDS) and the changes in pattern over time.
Prospective observational study. Serum samples of 70 ARDS patients were analyzed for primary bile acids (cholic acid, chenodeoxycholic acid) and secondary bile acids (deoxycholic acid, litocholic acid, and ursodeoxycholic acid) as well as their glycine and taurine glycation products.
Primary bile acid levels increased from day zero to day five by almost 50% (p<0.05). This change bases on a statistically significant increase in all primary bile acids between day 0 and day 5 (cholic acid [CA] p=0.001, taurocholic acid [TCA] p=0.004, glycocholic acid [GCA] p<0.001, chenodeoxycholic acid [CDCA] p=0.036, taurochenodeoxycholic acid [TCDCA] p<0.001, glycochenodeoxycholic acid [GCDCA] p<0.001). Secondary bile acids showed predominantly decreased levels on day 0 compared to the control group and remained stable throughout the study period; the differences between day zero and day five were not statistically significant. Non-survivors exhibited significantly higher levels of TCDCA on day 5 (p<0.05) than survivors. This value was also independently associated with survival in a logistic regression model with an odds ratio of 2.24 (95% CI 0.53-9.46).
The individual bile acid profile of this ARDS patient cohort is unique compared to other disease states. The combination of changes in individual bile acids reflects a shift toward the acidic pathway of bile acid synthesis. Our results support the concept of ARDS-specific plasma levels of bile acids in a specific pattern as an adaptive response mechanism.
在危重病患者中，胆汁淤积和血清胆汁酸水平升高很常见。本研究旨在确定与急性呼吸窘迫综合征（ARDS）相关的特定胆汁酸模式及其随时间的变化。
前瞻性观察性研究。对 70 例 ARDS 患者的血清样本进行分析，以检测初级胆汁酸（胆酸、鹅去氧胆酸）和次级胆汁酸（脱氧胆酸、石胆酸和熊去氧胆酸）及其甘氨酸和牛磺酸糖化产物。
从第 0 天到第 5 天，初级胆汁酸水平增加了近 50%（p<0.05）。这一变化基于第 0 天到第 5 天所有初级胆汁酸的统计学显著增加（胆酸[CA]p=0.001，牛磺胆酸[TCA]p=0.004，甘氨胆酸[GCA]p<0.001，鹅去氧胆酸[CDCA]p=0.036，牛磺鹅去氧胆酸[TCDCA]p<0.001，甘氨鹅去氧胆酸[GCDCA]p<0.001）。第 0 天与对照组相比，次级胆汁酸水平主要降低，且整个研究期间保持稳定；第 0 天与第 5 天之间的差异无统计学意义。与幸存者相比，非幸存者在第 5 天的 TCDCA 水平显著更高（p<0.05）。在 logistic 回归模型中，该值与存活率独立相关，优势比为 2.24（95%CI 0.53-9.46）。
与其他疾病状态相比，该 ARDS 患者队列的个体胆汁酸谱是独特的。个体胆汁酸变化的组合反映了胆汁酸合成向酸性途径的转变。我们的研究结果支持 ARDS 特定的胆汁酸在特定模式下的血浆水平作为一种适应机制的概念。
