Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Biostatistics, Indiana University, Bloomington, IN, USA.
Sci Rep. 2024 Apr 10;14(1):8427. doi: 10.1038/s41598-024-58522-9.
Impaired physical function contributes to falls, fractures, and mortality among patients undergoing dialysis. Using a metabolomic approach, we identified metabolite alterations and effect size-based composite scores for constructs of impaired gait speed and grip strength. 108 participants incident to dialysis had targeted plasma metabolomics via liquid chromatography-mass spectrometry and physical function assessed (i.e., 4 m walk, handgrip strength). Physical function measures were categorized as above/ below median, with grip utilizing sex-based medians. To develop composite scores, metabolites were identified via Wilcoxon uncorrected p < 0.05 and effect size > 0.40. Receiver operating characteristic analyses tested whether scores differentiated between above/below function groups. Participants were 54% male, 77% Black and 53 ± 14 y with dialysis vintage of 101 ± 50 days. Median (IQR) grip strength was 35.5 (11.1) kg (males) and 20 (8.4) kg (females); median gait speed was 0.82 (0.34) m/s. Of 246 measured metabolites, composite scores were composed of 22 and 12 metabolites for grip strength and gait speed, respectively. Area under the curve for metabolite composite was 0.88 (gait) and 0.911 (grip). Composite scores of physical function performed better than clinical parameters alone in patients on dialysis. These results provide potential pathways for interventions and needed validation in an independent cohort.
身体机能障碍会导致透析患者跌倒、骨折和死亡。我们采用代谢组学方法，确定了代谢物的变化，并基于效应大小构建了与步态速度和握力受损相关的综合评分。108 名新进入透析的患者通过液相色谱-质谱法进行了靶向血浆代谢组学分析，并进行了身体功能评估（即 4 米步行、握力）。身体功能测量值被分为高于/低于中位数，握力则使用基于性别的中位数。为了构建综合评分，通过 Wilcoxon 未校正 p < 0.05 和效应大小 > 0.40 确定代谢物。受试者 54%为男性，77%为黑人，年龄 53 ± 14 岁，透析龄 101 ± 50 天。中位数（IQR）握力为 35.5（11.1）kg（男性）和 20（8.4）kg（女性）；中位数步态速度为 0.82（0.34）m/s。在 246 种测量的代谢物中，握力和步态速度的综合评分分别由 22 和 12 种代谢物组成。代谢物综合评分的曲线下面积为 0.88（步态）和 0.911（握力）。与单独的临床参数相比，透析患者的身体功能综合评分表现更好。这些结果为干预措施提供了潜在途径，需要在独立队列中进行验证。
