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Canadian Respiratory Journal
Volume 2017, Article ID 9480346, 9 pages
Research Article

Metabolomics in COPD Acute Respiratory Failure Requiring Noninvasive Positive Pressure Ventilation

1Pulmonary, Department of Medicine, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
2Critical Care and Acute Care Surgery Division, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
3Pulmonary and Critical Care Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA

Correspondence should be addressed to Spyridon Fortis; ude.awoiu@sitrof-nodiryps

Received 20 July 2017; Revised 24 September 2017; Accepted 16 October 2017; Published 17 December 2017

Academic Editor: Frederik Trinkmann

Copyright © 2017 Spyridon Fortis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We aimed to investigate whether metabolomic analysis can discriminate acute respiratory failure due to COPD exacerbation from respiratory failure due to heart failure and pneumonia. Since COPD exacerbation is often overdiagnosed, we focused on those COPD exacerbations that were severe enough to require noninvasive mechanical ventilation. We enrolled stable COPD subjects and patients with acute respiratory failure requiring noninvasive mechanical ventilation due to COPD, heart failure, and pneumonia. We excluded subjects with history of both COPD and heart failure and patients with obstructive sleep apnea and obstructive lung disease other than COPD. We performed metabolomics analysis using NMR. We constructed partial least squares discriminant analysis (PLS-DA) models to distinguish metabolic profiles. Serum (, R2 = 0.397, Q2 = 0.058) and urine metabolic profiles (, R2 = 0.419, Q2 = 0.142) were significantly different between the four diagnosis groups by PLS-DA. After excluding stable COPD patients, the metabolomes of the various respiratory failure groups did not cluster separately in serum (, R2 = 0.631, Q2 = 0.246) or urine (, R2 = 0.602, Q2 = −0.134). However, several metabolites in the serum were reduced in patients with COPD exacerbation and pneumonia. We did not find a metabolic profile unique to COPD exacerbation, but we were able to clearly and reliably distinguish stable COPD patients from patients with respiratory failure in both serum and urine.