Metabolomics in COPD Acute Respiratory Failure Requiring Noninvasive Positive Pressure Ventilation

• Published in: Canadian respiratory journal Vol. 2017; no. 2017; pp. 1 - 9
• Main Authors: Beilman, Greg J., Weinert, Craig R., Lusczek, Elizabeth R., Fortis, Spyridon
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01.01.2017; Hindawi; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Aged; Aged, 80 and over; Analysis; Biochemistry; Biomarkers; Case-Control Studies; Chronic obstructive pulmonary disease; Critical care; Discriminant Analysis; Disease Progression; Female; Heart failure; Heart Failure - metabolism; Heart Failure - therapy; Hospitals; Humans; Hypotheses; Inflammation; Kidney diseases; Least-Squares Analysis; Lung diseases; Magnetic Resonance Spectroscopy; Male; Metabolism; Metabolites; Metabolomics; Middle Aged; Mortality; NMR; Noninvasive Ventilation; Nuclear magnetic resonance; Pneumonia; Pneumonia - metabolism; Pneumonia - therapy; Positive-Pressure Respiration; Pulmonary Disease, Chronic Obstructive - metabolism; Pulmonary Disease, Chronic Obstructive - therapy; Quality of life; Respiratory failure; Respiratory insufficiency; Respiratory Insufficiency - metabolism; Respiratory Insufficiency - therapy; Sleep apnea syndromes; Statistical analysis; Studies; Urine; Ventilators
• ISSN: 1198-2241; 1916-7245
• DOI: 10.1155/2017/9480346

We aimed to investigate whether metabolomic analysis can discriminate acute respiratory failure due to COPD exacerbation from respiratory failure due to heart failure and pneumonia. Since COPD exacerbation is often overdiagnosed, we focused on those COPD exacerbations that were severe enough to require noninvasive mechanical ventilation. We enrolled stable COPD subjects and patients with acute respiratory failure requiring noninvasive mechanical ventilation due to COPD, heart failure, and pneumonia. We excluded subjects with history of both COPD and heart failure and patients with obstructive sleep apnea and obstructive lung disease other than COPD. We performed metabolomics analysis using NMR. We constructed partial least squares discriminant analysis (PLS-DA) models to distinguish metabolic profiles. Serum (p=0.001, R2 = 0.397, Q2 = 0.058) and urine metabolic profiles (p<0.001, R2 = 0.419, Q2 = 0.142) were significantly different between the four diagnosis groups by PLS-DA. After excluding stable COPD patients, the metabolomes of the various respiratory failure groups did not cluster separately in serum (p=0.2, R2 = 0.631, Q2 = 0.246) or urine (p=0.065, R2 = 0.602, Q2 = −0.134). However, several metabolites in the serum were reduced in patients with COPD exacerbation and pneumonia. We did not find a metabolic profile unique to COPD exacerbation, but we were able to clearly and reliably distinguish stable COPD patients from patients with respiratory failure in both serum and urine.