Metabolic phenotyping for monitoring surgical patients

Abstract

Operating theatres are traditionally largely free of chemical diagnostic information, because the timescale for surgical decision making is shorter than that for most clinical analytical procedures. 1 Garcia-Miguel FJ Serrano-Aguilar PG López-Bastida J Preoperative assessment. Lancet. 2003; 362: 1749-1757 Summary Full Text Full Text PDF PubMed Scopus (148) Google Scholar Clinical risk scores have variable sensitivity and specificity, 2 Can MF Yagci G Tufan T Ozturk E Zeybek N Cetiner S Can SAPS II predict operative mortality more accurately than POSSUM and P-POSSUM in patients with colorectal carcinoma undergoing resection?. World J Surg. 2008; 32: 589-595 Crossref PubMed Scopus (14) Google Scholar and by definition they are not personalised, so more robust prognostic markers are needed to improve the quality of surgical care. 3 The LancetWhat is the point of surgery?. Lancet. 2010; 376: 1025 Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar Rapid metabolic phenotyping approaches (known as metabotyping), which use nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry of tissue biopsy or biofluid samples, 4 Lindon JC Nicholson JK Analytical technologies for metabonomics and metabolomics, and multi-omic information recovery. Trends Analyt Chem. 2008; 3: 194-204 Crossref Scopus (125) Google Scholar have proven useful for generation of diagnostic biomarker information about many diseases in human beings. 5 Holmes E Wilson ID Nicholson JK Metabolic phenotyping in health and disease. Cell. 2008; 134: 714-717 Summary Full Text Full Text PDF PubMed Scopus (573) Google Scholar , 6 Holmes E Loo RL Stamler J et al. Human metabolic phenotype diversity and its association with diet and blood pressure. Nature. 2008; 453: 396-400 Crossref PubMed Scopus (866) Google Scholar , 7 Nicholson JK Lindon JC Systems biology: metabonomics. Nature. 2008; 455: 1054-1105 Crossref PubMed Scopus (1429) Google Scholar The techniques have also been widely used in animals to investigate disease, including the effects of surgical trauma on host physiology. 8 Kinross JM Alkhamesi N Barton RH et al. Global metabolic phenotyping in an experimental laparotomy model of surgical trauma. J Proteome Res. 2011; 10: 277-287 Crossref PubMed Scopus (59) Google Scholar The deployment of such technologies in operating theatres could provide sensitive, specific, and efficient vehicles for the delivery of novel real-time diagnostic information, to aid surgical decision making.