Abstract
Introduction: Detection of early metabolic changes in critically-ill coronavirus disease 2019 (COVID-19) patients under invasive mechanical ventilation (IMV) at the intensive care unit (ICU) could predict recovery patterns and help in disease management.Methods: Targeted metabolomics of serum samples from 39 COVID-19 patients under IMV in ICU was performed within 48 h of intubation and a week later. A generalized linear model (GLM) was used to identify, at both time points, metabolites and clinical traits that predict the length of stay (LOS) at ICU (short ≤ 14 days/long >14 days) as well as the duration under IMV. All models were initially trained on a set of randomly selected individuals and validated on the remaining individuals in the cohort. Further validation in recently published metabolomics data of COVID-19 severity was performed.Results: A model based on hypoxanthine and betaine measured at first time point was best at predicting whether a patient is likely to experience a short or long stay at ICU [area under curve (AUC) = 0.92]. A further model based on kynurenine, 3-methylhistidine, ornithine, p-cresol sulfate, and C24.0 sphingomyelin, measured 1 week later, accurately predicted the duration of IMV (Pearson correlation = 0.94). Both predictive models outperformed Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and differentiated COVID-19 severity in published data.Conclusion: This study has identified specific metabolites that can predict in advance LOS and IMV, which could help in the management of COVID-19 cases at ICU.
Highlights
Detection of early metabolic changes in critically-ill coronavirus disease 2019 (COVID-19) patients under invasive mechanical ventilation (IMV) at the intensive care unit (ICU) could predict recovery patterns and help in disease management
Thirty-nine mid-age (48 ± 11.1 years) critically-ill patients were recruited among patients admitted to the ICU at Hamad Medical Corporation (HMC)
Certain clinical features significantly increased during the 1st week at ICU, including arterial pH, serum lactate, triglycerides, alanine aminotransferase (ALT), albumin, bicarbonate, phosphorus, mean corpuscular volume (MCV), white blood cells (WBC), percentage of monocytes, and C-reactive protein (CRP), whereas both fibrinogen and partial thromboplastin time (PTT) were significantly reduced during the 1st week at ICU
Summary
Detection of early metabolic changes in critically-ill coronavirus disease 2019 (COVID-19) patients under invasive mechanical ventilation (IMV) at the intensive care unit (ICU) could predict recovery patterns and help in disease management. One-fifth of COVID-19 patients exhibits respiratory distress that necessitates instant oxygen therapy or hospital interventions such as invasive mechanical ventilation (IMV) [1, 2]. Among the critically-ill patients admitted to the intensive care unit (ICU), Metabolomics of COVID-19 ICU Patients one-third of patients dies [3]. The accuracy of early clinical prediction of IMV duration remains limited, especially in patients who will require longer IMV [4]. Markers that can predict patients’ evolution at ICU may be legitimate targets for intervention to improve the patient clinical profile at ICU
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