Measurement of Serum Levels of 5 Amino Acids and Dimethylamine Using Liquid Chromatography-Tandem Mass Spectrometry in Patients without Septic Associated Acute Kidney Injury and with Septic Associated Acute Kidney Injury Requiring Continuous Renal Replacement Therapy

Abstract

Background Acute kidney injury (AKI) is one of the most common organ failures. An early diagnosis of AKI using specific biomarkers is essential for effective treatment. This study determined the serum concentrations of selected amino acids and amines using targeted liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) in patients with AKI during sepsis and septic shock treated in the Intensive Care Unit (ICU). Material/Methods A sample of 41 patients was divided into 2 groups: (1) patients with sepsis and septic shock along required continuous renal replacement therapy (CRRT) due to AKI (n=13), and (2) patients with sepsis and septic shock but without AKI (n=28). LC-MS/MS was used to measure a serum concentration of 6 amino acids and amines: arginine, ornithine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), dimethylamine (DMA), and citrulline. Results There was a statistically significantly higher median DMA level in AKI patients compared to those without AKI (8.1 vs 5.2 umol/L; P =0.022). The results for the remaining molecules showed no significant differences ( P >0.05). Patients with DMA ≥14.95 umol/L (n=5; 100%) and treated with CRRT presented DMA level below the cut-off point (n=7; 20%). Subjects with creatinine levels ≥1.19 mg/dL (n=11; 28%) and treated with CRRT presented creatinine levels below the cut-off point (n=1; 3%). Conclusions In patients with sepsis, increased serum levels of DMA were significantly associated with AKI requiring CRRT. It remains unclear whether increased DMA concentrations are secondary to sepsis-induced AKI or are a cause.

Surviving Sepsis Campaign Research Priorities 2023

“…Some may roughly reflect the magnitude of the organ pathology—for example, liver injury (increasing transaminases levels), liver dysfunction (e.g., modestly increased bilirubin levels), liver failure (high bilirubin, profound coagulopathy), but there are, admittedly, many confounders. Human studies have demonstrated alterations in levels of numerous biomarkers in sepsis, and their correlation with organ failure and mortality, including markers of endothelial activation and injury, long noncoding RNAs, cancer protein biomarkers, and brain natriuretic peptide (64–68). Markers of leukocyte activation and function also associate with sepsis outcomes (67, 69–72).…”

Serum metabolite profiling reveals metabolic characteristics of sepsis patients using LC/MS-based metabolic profiles: a cross-sectional study

“…As anticipated, sepsis patients displayed decreased levels of glutamate, leucine, phenylalanine, tryptophan and tyrosine [ 5 ]. Serum dimethylamine concentrations were found to be elevated in septic shock patients with acute kidney injury by targeted liquid chromatography-tandem mass spectrometry [ 11 ].…”