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In-hospital metabolite changes in infective endocarditis-a longitudinal H-1 NMR-based study

Journal article
Authors C. F. Klein
S. L. K. Holle
M. H. Andersen
Anders Pedersen
H. Bundgaard
K. K. Iversen
A. Malmendal
Published in European Journal of Clinical Microbiology & Infectious Diseases
Volume 38
Issue 8
Pages 1553-1560
ISSN 0934-9723
Publication year 2019
Published at Swedish NMR Centre at Göteborg University
Pages 1553-1560
Language en
Keywords Infective endocarditis, Antibiotic treatment, Metabolomics, NMR, Longitudinal study, antimicrobial therapy, metabolomics, management, diagnosis, systems, serum, Infectious Diseases, Microbiology
Subject categories Infectious Medicine


Treatment of infective endocarditis (IE) is a 4-6-week provided course of intravenously administered antibiotics. The aim of this study was to investigate how serum metabolites as measured by proton nuclear magnetic resonance (H-1 NMR) spectroscopy are changing over time during the active phase of IE, and to see whether these metabolite changes might be used to monitor recovery in these patients. Patients hospitalized with first-time IE at Herlev Hospital, Denmark, from September 2015 to June 2017 were included. Longitudinal blood sampling was performed and serum was analyzed using H-1 NMR. Orthogonal projection to latent structures discriminant analysis (OPLS-DA) was used to separate sample groups and analyze differences in metabolite profiles. Thirteen patients were included in the study (77% men, median age 62 years (IQR 53-77)). All patients were cured during the hospitalization without any relapse during 6 months of follow-up. We analyzed 61 serum samples (median 5 samples, range 2-8 per person) drawn in the treatment period after IE diagnosis. The main changes during the in-hospital period were decreased levels of glucose, mannose, leucine, isoleucine, phenylalanine, tyrosine, and signals from polyols and N-acetylated protein. The metabolomic changes could in contrast to the routinely used parameters CRP and leucocyte levels distinguish between the early and late stages of disease treatment. We present the first longitudinal study of H-1 NMR metabolomics in patients with infective endocarditis. The metabolomic changes show a promising strength compared to routinely used clinical parameters.

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