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Trimethylamine-N-oxide (TMAO) predicts short- and long-term mortality and poor neurological outcome in out-of-hospital cardiac arrest patients

  • Seraina R. Hochstrasser , Kerstin Metzger , Alessia M. Vincent , Christoph Becker , Annalena K. J. Keller , Katharina Beck , Sebastian Perrig , Kai Tisljar , Raoul Sutter , Philipp Schuetz , Luca Bernasconi , Peter Neyer , Stephan Marsch and Sabina Hunziker EMAIL logo
Published/Copyright: August 31, 2020
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 59 Issue 2

Abstract

Objectives

Prior research found the gut microbiota-dependent and pro-atherogenic molecule trimethylamine-N-oxide (TMAO) to be associated with cardiovascular events as well as all-cause mortality in different patient populations with cardiovascular disease. Our aim was to investigate the prognostic value of TMAO regarding clinical outcomes in patients after out-of-hospital cardiac arrest (OHCA).

Methods

We included consecutive OHCA patients upon intensive care unit admission into this prospective observational study between October 2012 and May 2016. We studied associations of admission serum TMAO with in-hospital mortality (primary endpoint), 90-day mortality and neurological outcome defined by the Cerebral Performance Category (CPC) scale.

Results

We included 258 OHCA patients of which 44.6% died during hospitalization. Hospital non-survivors showed significantly higher admission TMAO levels (μmol L−1) compared to hospital survivors (median interquartile range (IQR) 13.2 (6.6–34.9) vs. 6.4 (2.9–15.9), p<0.001). After multivariate adjustment for other prognostic factors, TMAO levels were significantly associated with in-hospital mortality (adjusted odds ratios (OR) 2.1, 95%CI 1.1–4.2, p=0.026). Results for secondary outcomes were similar with significant associations with 90-day mortality and neurological outcome in univariate analyses.

Conclusions

In patients after OHCA, TMAO levels were independently associated with in-hospital mortality and other adverse clinical outcomes and may help to improve prognostication for these patients in the future. Whether TMAO levels can be influenced by nutritional interventions should be addressed in future studies.

Keywords: cardiac arrest; metabolomics; outcome prediction
Corresponding author: Prof. Sabina Hunziker, MD, MPH, Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; and Faculty of Medicine, University of Basel, Basel, Switzerland, E-mail:
Seraina Rahel Hochstrasser and Kerstin Metzger contributed equally to this article and are considered equally first authors.

Funding source: Gottfried und Julia Bangerter-Rhyner-Stiftung

Award Identifier / Grant number: 8472/HEG-DSV

  1. Research funding: Gottfried und Julia Bangerter-Rhyner-Stiftung, 8472/HEG-DSV.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The study was conducted in accordance with the Declaration of Helsinki and was approved by the local Ethics Committee (Ethics Committee of Northwest and Central Switzerland, Ethikkommission Nordwest- und Zentralschweiz, EKNZ).

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/ijcre-2019-0226).

Received: 2020-02-15
Accepted: 2020-08-06
Published Online: 2020-08-31
Published in Print: 2021-02-23

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2020-0159
Keywords for this article
cardiac arrest; metabolomics; outcome prediction

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Assuring the quality of examinations using faecal immunochemical tests for haemoglobin (FIT)
  4. Review
  5. Capillary electrophoresis based on nucleic acid analysis for diagnosing inherited diseases
  6. Mini Reviews
  7. Negative hair test result after long-term drug use. About a case involving morphine and literature review
  8. Prorenin and active renin levels in paediatrics: a bioanalytical review
  9. Opinion Paper
  10. From therapeutic drug monitoring to total drug monitoring and drug-omics
  11. Perspectives
  12. The internal quality control in the traceability era
  13. Genetics and Molecular Diagnostics
  14. External quality assessment (EQA) and alternative assessment procedures (AAPs) in molecular diagnostics: findings of an international survey
  15. General Clinical Chemistry and Laboratory Medicine
  16. An evaluation of ten external quality assurance scheme (EQAS) materials for the faecal immunochemical test (FIT) for haemoglobin
  17. Optimizing hepcidin measurement with a proficiency test framework and standardization improvement
  18. Development of a certified reference material for anti-β2-glycoprotein I IgG – commutability studies
  19. Influence of patients’ clinical features at intensive care unit admission on performance of cell cycle arrest biomarkers in predicting acute kidney injury
  20. Efficacy of weekly administration of cholecalciferol on parathyroid hormone in stable kidney-transplanted patients with CKD stage 1–3
  21. Plasma metanephrines and prospective prediction of tumor location, size and mutation type in patients with pheochromocytoma and paraganglioma
  22. Emicizumab, the factor VIII mimetic bi-specific monoclonal antibody and its measurement in plasma
  23. Reference Values and Biological Variations
  24. Age appropriate reference intervals for eight kidney function and injury markers in infants, children and adolescents
  25. Cardiovascular Diseases
  26. Comparison of acetylsalicylic acid and clopidogrel non-responsiveness assessed by light transmittance aggregometry and PFA-100® in patients undergoing neuroendovascular procedures
  27. Trimethylamine-N-oxide (TMAO) predicts short- and long-term mortality and poor neurological outcome in out-of-hospital cardiac arrest patients
  28. Non-lactate strong ion difference and cardiovascular, cancer and all-cause mortality
  29. Infectious Diseases
  30. Performance of three automated SARS-CoV-2 antibody assays and relevance of orthogonal testing algorithms
  31. Development, evaluation, and validation of machine learning models for COVID-19 detection based on routine blood tests
  32. Searching for a role of procalcitonin determination in COVID-19: a study on a selected cohort of hospitalized patients
  33. Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a patient-level meta-analysis from randomized controlled trials
  34. Erratum
  35. Corrigendum to: The role of hyperhomocysteinemia as well as folate, vitamin B6 and B12 deficiencies in osteoporosis – a systematic review
  36. Letter to the Editors
  37. Harmonization of antineutrophil cytoplasmic antibodies (ANCA) testing by reporting test result-specific likelihood ratios: position paper
  38. Independent internal quality control (IQC) for faecal immunochemical tests (FIT) for haemoglobin: use of FIT manufacturers’ IQC for other FIT systems
  39. Parallel testing of 241 clinical nasopharyngeal swabs for the detection of SARS-CoV-2 virus on the Cepheid Xpert Xpress SARS-CoV-2 and the Roche cobas SARS-CoV-2 assays
  40. Sustained SARS-CoV-2 nucleocapsid antibody levels in nonsevere COVID-19: a population-based study
  41. Evidence for increased circulating procoagulant phospholipids in patients with COVID-19 pneumonia and their prognostic role
  42. Complete blood counts and cell population data from Sysmex XN analyser in the detection of SARS-CoV-2 infection
  43. Macro creatine kinase in an asymptomatic patient: a case report
  44. Implementation of pre-labelled barcode tubes and the GeT-System in a general hospital for the exact documentation of the time of venous blood sample and improvement of sample quality
  45. Determination of free light chains: assay-dependent differences in interpretation
  46. Association between SOX17, Wif-1 and RASSF1A promoter methylation status and response to chemotherapy in patients with metastatic gastric cancer
  47. Effect of two organizational interventions on the frequency of haemoglobin A1c and erythrocyte sedimentation rate testing
  48. Haemoglobin A1c determination from dried blood spots prepared with HemaSpot™ blood collection devices: comparison with fresh capillary blood
  49. Stability of catecholamines in whole blood: influence of time between collection and centrifugation
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