Serial Plasma Choline Measurements after Cardiac Arrest in Patients Undergoing Mild Therapeutic Hypothermia: A Prospective Observational Pilot Trial

Abstract

ObjectiveCholine is related to phospholipid metabolism and is a marker for global ischaemia with a small reference range in healthy volunteers. The aim of our study was to characterize the early kinetics of plasma free choline in patients after cardiac arrest. Additionally, we investigated the potential of plasma free choline to predict neurological outcome.MethodsTwenty patients admitted to our medical intensive care unit were included in this prospective, observational trial. All patients were enrolled between May 2010 and May 2011. They received post cardiac arrest treatment including mild therapeutic hypothermia which was initiated with a combination of cold fluid and a feedback surface cooling device according to current guidelines. Sixteen blood samples per patient were analysed for plasma free choline levels within the first week after resuscitation. Choline was detected by liquid chromatography-tandem mass spectrometry.ResultsMost patients showed elevated choline levels on admission (median 14.8 µmol/L; interquartile range; IQR 9.9-20.1) which subsequently decreased. 48 hours after cardiac arrest choline levels in all patients reached subnormal levels at a median of 4.0 µmol/L (IQR 3-4.9; p = 0.001). Subsequently, choline levels normalized within seven days. There was no significant difference in choline levels when groups were analyzed in relation to neurological outcome.ConclusionsOur data indicate a choline deficiency in the early postresucitation phase. This could potentially result in impaired cell membrane recovery. The detailed characterization of the early choline time course may aid in planning of choline supplementation trials. In a limited number of patients, choline was not promising as a biomarker for outcome prediction.

NMR-based metabolomics in real-time monitoring of treatment induced toxicity and cachexia in head and neck cancer: a method for early detection of high risk patients

“…The augmented utilization of phosphocholine for repairing the damaged cells/organelles under severe oxidative and systemic inflammatory condition should also lead to decrease in total Cho. On the other hand, in hypoxic states choline is released from hypoxic tissue into the plasma, thus increasing the basal circulating levels (Storm et al 2013). The efficient source of choline is phosphatidylcholine hydrolysis (Fagone and Jackowski 2013).…”

Measurement of plasma choline in acute coronary syndrome: importance of suitable sampling conditions for this assay

“…More recently, Storm et al . suggested that the plasma choline levels decreased 6–12 hours after the return of spontaneous circulation and reached a subnormal concentration, with a median of 4.0 μmol/L 35 . Until now, no reports have described the use of prepared samples in which the blood collection tubes were kept on ice prior to centrifugation.…”