Leonardo Meggiolaro, Laura Moschino, Matteo Stocchero, Giuseppe Giordano, Vladimiro Vida, Giovanni Di Salvo, Eugenio Baraldi
{"title":"Metabolomic profiling of infants undergoing cardiopulmonary bypass and association with clinical outcomes: a systematic review.","authors":"Leonardo Meggiolaro, Laura Moschino, Matteo Stocchero, Giuseppe Giordano, Vladimiro Vida, Giovanni Di Salvo, Eugenio Baraldi","doi":"10.3389/fcvm.2024.1491046","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>We conducted a systematic review (<i>PROSPERO</i>: 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/, PROSPERO ID 565112.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1491046"},"PeriodicalIF":2.8000,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602462/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Cardiovascular Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fcvm.2024.1491046","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: 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.
Methods: We conducted a systematic review (PROSPERO: 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.
Results: 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.
Conclusion: 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.
Systematic review registration: https://www.crd.york.ac.uk/prospero/, PROSPERO ID 565112.
导读：接受复杂先天性心脏病（CHD）手术合并体外循环（CPB）的婴儿短期不良预后的发生率仍然很高。早期识别和治疗高危患者仍然具有挑战性，特别是因为临床风险因素往往无法解释这一弱势群体的不同结局。代谢组学提供了深入了解患者的表型和遗传底物和采样时环境影响之间的复杂相互作用。由于这些原因，这可能有助于确定在接受先天性心脏手术的新生儿中经历的生理病理破坏机制，并确定潜在的治疗靶点。方法：我们进行了一项系统综述（PROSPERO: ID 565112），研究了接受选择性CPB手术治疗冠心病的婴儿的靶向或非靶向代谢组学分析与临床结果之间的关系。遵循了PRISMA准则。我们通过PubMed检索MEDLINE，通过Ovid检索EMBASE， Cochrane中央对照试验注册库，Cochrane图书馆，ClinicalTrials.gov和世界卫生组织的国际试验注册和平台。结果：纳入7项研究，涉及509名儿童（年龄1天至21.3个月），均接受了需要CPB的心脏手术，用于定性分析。我们发现代谢组学特征与各种临床结果，如死亡率、急性肾损伤（AKI）和神经预后之间存在关联。特定代谢物（主要是氨基酸及其代谢产物和脂肪酸）被确定为这些结果的潜在生物标志物，证明了代谢组学在预测某些术后并发症方面的实用性。结论：由于研究设计的异质性和样本量小，证据的质量有限，但研究结果是有希望的，并表明有必要进一步研究来证实这些关联。系统评审注册：https://www.crd.york.ac.uk/prospero/, PROSPERO ID 565112。
期刊介绍：
Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers?
At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
