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Review
. 2020 Aug 12;24(1):499.
doi: 10.1186/s13054-020-03208-7.

Biomarkers in critical care nutrition

Christian Stoppe  1   2 , Sebastian Wendt  1 , Nilesh M Mehta  3 , Charlene Compher  4 , Jean-Charles Preiser  5 , Daren K Heyland  6   7 , Arnold S Kristof  8
Affiliations
Review

Biomarkers in critical care nutrition

Christian Stoppe et al. Crit Care. .

Abstract

The goal of nutrition support is to provide the substrates required to match the bioenergetic needs of the patient and promote the net synthesis of macromolecules required for the preservation of lean mass, organ function, and immunity. Contemporary observational studies have exposed the pervasive undernutrition of critically ill patients and its association with adverse clinical outcomes. The intuitive hypothesis is that optimization of nutrition delivery should improve ICU clinical outcomes. It is therefore surprising that multiple large randomized controlled trials have failed to demonstrate the clinical benefit of restoring or maximizing nutrient intake. This may be in part due to the absence of biological markers that identify patients who are most likely to benefit from nutrition interventions and that monitor the effects of nutrition support. Here, we discuss the need for practical risk stratification tools in critical care nutrition, a proposed rationale for targeted biomarker development, and potential approaches that can be adopted for biomarker identification and validation in the field.

Keywords: Biomarker; Critical care; Metabolism; Nutrition.

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Conflict of interest statement

None of the authors reports any competing interests.

Figures

Fig. 1
Fig. 1
a Clinical decision-making and RCTs operate on the hypothesis that an individual or population at risk is administered a therapeutic intervention that leads to a salutary biological response and a better health outcome (gray). Biomarkers (BM; orange) are used to monitor therapeutic responses or to define subsets of the population most likely to benefit from the intervention (Rx). b RCTs in the critical care nutrition field have assumed homogeneous (blue) nutritional risk, and they have not exploited biomarkers (red interrogation mark) to target patients at risk or to time nutritional interventions. Outcomes have been equivocal or difficult to interpret. c ICU patients exhibit metabolic heterogeneity (mixed colors), and multidimensional assays (bar codes) are best to capture the patients’ endotypes (e.g., blue) that predict clinical responses to nutrition support (red plus sign). Multidimensional biomarkers can be used to limit enrollment to those patients most likely to benefit (blue) or to enrich the results by classifying patients during post hoc analyses. Biomarker panels can be generated using new omics technologies that measure biological properties that are highly linked to nutrition and metabolism. Primary candidates are genomic, transcriptomic, epigenomic, and microbiome-based assays, which can then be reduced and implemented in non-invasive point-of-care assays
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