Blood metabolomic profiling predicts postoperative gastrointestinal function of colorectal surgical patients under the guidance of goal-directed fluid therapy

Abstract

Background: Postoperative gastrointestinal function in uences postoperative recovery and hospital stay length for patients undergoing colorectal surgery. Goal-directed uid therapy (GDFT) restricts uid administration to an amount required to prevent dehydration. Although the uid management of GDFT could decrease the incidence of postoperative complications in patients who undergo high-risk surgery, certain patients may not respond to GDFT. Thus, to achieve optimal treatment, identi cation of patients suitable for GDFT is necessary. Accordingly, in this study, we evaluated the predictive capacity of metabolomics pro ling for postoperative recovery after surgery for colorectal cancer. Methods: Metabolomic pro ling of 48 patients with colorectal cancer who underwent surgery was performed. Patients were divided into delayed-and enhanced-recovered groups based on gastrointestinal function within 72 hours, and the results of-omics analysis showed differential serum metabolites between the two groups of patients in the postanesthesia care unit 24 hours after surgery. A support vector machine model was applied to evaluate the curative effects of GDFT in different patients. Results: Four metabolites, oleamide, ubiquinone-1, acetylcholine, and oleic acid, were found to be highly associated with postoperative gastrointestinal function and could serve as potential biomarkers. Moreover, four pathways were found to be highly related to postoperative gastrointestinal recovery. Among these, the vitamin B6 metabolism pathway may be a common pathway for improving postoperative recovery in various diseases. Conclusion: Our ndings proposed a novel method to predict postoperative recovery of gastrointestinal function based on metabolomic pro ling and suggested the potential mechanisms contributing to gastrointestinal function after surgical resection of colorectal cancer under the uid management of GDFT.

Prediction of Complications and Prognostication in Perioperative Medicine: A Systematic Review and PROBAST Assessment of Machine Learning Tools

“…The system was modeled around a specific electronic health record system and could potentially be adapted to other electronic health records. The second, from Xie et al , 73 used blood metabolomic profiling to predict the risk of postoperative gastrointestinal failure.…”

“…Elective noncardiac surgery Mortality 30 days and/or 1 yr [26][27][28][29][30][31][32][33][34][35][36][37][38] In surgical patients with perioperative SarS-CoV-2 39 Morbidity Multiple postoperative complications 26,27,29,[40][41][42][43][44][45][46][47][48][49][50][51] acute and chronic pain 52-57 acute kidney failure 52,58-63 aSa score prediction 64 Delirium and cognitive decline [65][66][67][68][69][70] Cerebral/myocardial infarction 71 Difficult intubation prediciton 72 Ileus 73 Infection risk [74][75][76] Myocardial injury 77 Nausea and vomiting 78 Obstructive apnoea screening 79 Perioperative transfusion 80,81 Postoperative atrial fibrillation 82 respiratory failure and depression Liver failure 117 Major bleeding 118,119 Kidney failure…”

Clinical study: the impact of goal-directed fluid therapy on volume management during enhanced recovery after surgery in gastrointestinal procedures

“…This article has primarily focused on intraoperative fluid management within the ERAS framework, without delving into preoperative and postoperative fluid management schemes ( Virág et al, 2022 ). Due to the current medical model and the roles assigned in implementing the overall ERAS program, anesthesiologists are primarily responsible for controlling and accurately managing the intraoperative stages of fluid management, while preoperative and postoperative fluid management is often carried out by surgeons ( Xie et al, 2021 ). This approach contradicts the concept of continuous and unified fluid management advocated by anesthesiologists during the perioperative period ( Weinberg et al, 2019 ; Zorrilla-Vaca et al, 2021 ).…”

Piglet cardiopulmonary bypass induces intestinal dysbiosis and barrier dysfunction associated with systemic inflammation

“…Additionally, with the multitude of other bacterial signaling through the gut–brain axis, gut–lung axis and gut–heart axis, an improved pre-operative microbiome and metabolite profile might reduce the inflammatory cascade in the post-operative state ( Schmitt et al, 2019 ; Lau et al, 2021 ). Furthermore, a healthier pre-operative microbiome might result in improved nutritional status both pre-operatively and nutrient utilization in the post-operative period ( Krajmalnik-Brown et al, 2012 ; Xie et al, 2021 ). Both components might result in faster wound healing and recovery.…”