• Chel Hee Lee, Mohammad M Banoei, Mariam Ansari, Matthew P Cheng, Francois Lamontagne, Donald Griesdale, David E Lasry, Koray Demir, Vinay Dhingra, Karen C Tran, Terry Lee, Kevin Burns, David Sweet, John Marshall, Arthur Slutsky, Srinivas Murthy, Joel Singer, David M Patrick, Todd C Lee, John H Boyd, Keith R Walley, Robert Fowler, Greg Haljan, Donald C Vinh, Alison Mcgeer, David Maslove, Puneet Mann, Kathryn Donohoe, Geraldine Hernandez, Genevieve Rocheleau, Uriel Trahtemberg, Anand Kumar, Ma Lou, Claudia Dos Santos, Andrew Baker, James A Russell, Brent W Winston, and *ARBs CORONA I. Investigators.
• Department of Critical Care Medicine, University of Calgary, Alberta, Canada.
• Crit Care. 2024 Feb 27; 28 (1): 6363.

RationaleAcute respiratory distress syndrome (ARDS) is a life-threatening critical care syndrome commonly associated with infections such as COVID-19, influenza, and bacterial pneumonia. Ongoing research aims to improve our understanding of ARDS, including its molecular mechanisms, individualized treatment options, and potential interventions to reduce inflammation and promote lung repair.ObjectiveTo map and compare metabolic phenotypes of different infectious causes of ARDS to better understand the metabolic pathways involved in the underlying pathogenesis.MethodsWe analyzed metabolic phenotypes of 3 ARDS cohorts caused by COVID-19, H1N1 influenza, and bacterial pneumonia compared to non-ARDS COVID-19-infected patients and ICU-ventilated controls. Targeted metabolomics was performed on plasma samples from a total of 150 patients using quantitative LC-MS/MS and DI-MS/MS analytical platforms.ResultsDistinct metabolic phenotypes were detected between different infectious causes of ARDS. There were metabolomics differences between ARDSs associated with COVID-19 and H1N1, which include metabolic pathways involving taurine and hypotaurine, pyruvate, TCA cycle metabolites, lysine, and glycerophospholipids. ARDSs associated with bacterial pneumonia and COVID-19 differed in the metabolism of D-glutamine and D-glutamate, arginine, proline, histidine, and pyruvate. The metabolic profile of COVID-19 ARDS (C19/A) patients admitted to the ICU differed from COVID-19 pneumonia (C19/P) patients who were not admitted to the ICU in metabolisms of phenylalanine, tryptophan, lysine, and tyrosine. Metabolomics analysis revealed significant differences between C19/A, H1N1/A, and PNA/A vs ICU-ventilated controls, reflecting potentially different disease mechanisms.ConclusionDifferent metabolic phenotypes characterize ARDS associated with different viral and bacterial infections.© 2024. The Author(s).

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