Meggiolaro Leonardo, Moschino Laura, Stocchero Matteo, Giordano Giuseppe, Vida Vladimiro, Di Salvo Giovanni, Baraldi Eugenio
Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy.
Fondazione Istituto di Ricerca Pediatrica Città Della Speranza, Padova, Italy.
Front Cardiovasc Med. 2024 Nov 14;11:1491046. doi: 10.3389/fcvm.2024.1491046. eCollection 2024.
The incidence of adverse short-term outcomes for infants who undergo complex congenital heart disease (CHD) surgery with cardiopulmonary bypass (CPB) is still high. Early identification and treatment of high-risk patients remain challenging, especially because clinical risk factors often fail to explain the different outcomes of this vulnerable population. Metabolomics offers insight into the phenotype of the patient and the complex interplay between the genetic substrate and the environmental influences at the time of sampling. For these reasons, it may be helpful to identify the mechanisms of physio-pathological disruptions experienced in neonates undergoing congenital heart surgery and to identify potential therapeutic targets.
We conducted a systematic review (: ID 565112) of studies investigating the association between targeted or untargeted metabolomic analysis of infants undergoing elective surgery with CPB for CHD and clinical outcomes. The PRISMA guidelines were followed. We searched MEDLINE via PubMed, EMBASE via Ovid, the Cochrane Central Register of Controlled Trials, the Cochrane Library, ClinicalTrials.gov and the World Health Organization's International Trials Registry and Platform.
Seven studies involving 509 children (aged 1 day to 21.3 months), all of whom underwent cardiac surgery requiring CPB, were included for qualitative analysis. We found associations between metabolomic profiles and various clinical outcomes, such as mortality, acute kidney injury (AKI), and neurological outcomes. Specific metabolites (mainly amino acids, their metabolic products and fatty acids) were identified as potential biomarkers for these outcomes, demonstrating the utility of metabolomics in predicting certain postoperative complications.
The quality of the evidence was limited due to heterogeneity in study designs and small sample sizes, but the findings are promising and suggest that further research is warranted to confirm these associations.
https://www.crd.york.ac.uk/prospero/, PROSPERO ID 565112.
接受体外循环（CPB）下复杂先天性心脏病（CHD）手术的婴儿短期不良结局的发生率仍然很高。高危患者的早期识别和治疗仍然具有挑战性，尤其是因为临床风险因素往往无法解释这一脆弱人群的不同结局。代谢组学有助于深入了解患者的表型以及采样时遗传底物与环境影响之间的复杂相互作用。出于这些原因，识别接受先天性心脏手术的新生儿所经历的生理病理紊乱机制并确定潜在的治疗靶点可能会有所帮助。
我们对研究接受择期CPB下CHD手术的婴儿的靶向或非靶向代谢组学分析与临床结局之间关联的研究进行了系统评价（：ID 565112）。遵循PRISMA指南。我们通过PubMed搜索MEDLINE，通过Ovid搜索EMBASE，检索Cochrane对照试验中央注册库、Cochrane图书馆、ClinicalTrials.gov以及世界卫生组织国际试验注册平台。
纳入了7项研究，共509名儿童（年龄1天至21.3个月），所有儿童均接受了需要CPB的心脏手术，进行定性分析。我们发现代谢组学特征与各种临床结局之间存在关联，如死亡率、急性肾损伤（AKI）和神经学结局。特定代谢物（主要是氨基酸、其代谢产物和脂肪酸）被确定为这些结局的潜在生物标志物，证明了代谢组学在预测某些术后并发症方面的实用性。
由于研究设计的异质性和样本量小，证据质量有限，但研究结果很有前景，表明有必要进行进一步研究以证实这些关联。
