Journal article
Disruption of the circadian rhythm of melatonin: A biomarker of critical illness severity
Sleep medicine, Vol.110, pp.60-67
10/01/2023
DOI: 10.1016/j.sleep.2023.07.033
PMCID: PMC11386949
PMID: 37541132
Abstract
Circadian dysrhythmias occur commonly in critically ill patients reflecting variable effects of underlying illness, ICU environment, and treatments. We retrospectively analyzed the relationship between clinical outcomes and 24-h urinary 6-sulfatoxymelatonin (aMT6s) excretion profiles in 37 critically ill patients with shock and/or respiratory failure. Nonlinear regression was used to fit a 24-h cosine curve to each patient's aMT6s profile, with rhythmicity determined by the zero-amplitude test. From these curves we determined acrophase, amplitude, phase, and night/day ratio. After assessing unadjusted relationships, we identified the optimal multivariate models for hospital survival and for discharge to home (vs. death or transfer to another facility). Normalized aMT6s rhythm amplitude was greater (p = 0.005) in patients discharged home than in those who were not, while both groups exhibited a phase delay. Patients with rhythmic aMT6s excretion were more likely to survive (OR 5.25) and be discharged home (OR 8.89; p < 0.05 for both) than patients with arrhythmic profiles, associations that persisted in multivariate modelling. In critically ill patients with shock and/or respiratory failure, arrhythmic and/or low amplitude 24-h aMT6s rhythms were associated with worse clinical outcomes, suggesting a role for the melatonin-based rhythm as a novel biomarker of critical illness severity.
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•Among ICU patients, 24-h urinary melatonin rhythms are frequently phase delayed.•The amplitude of the aMT6s rhythm is significantly greater in ICU patients discharged home than not.•Patients with rhythmic aMT6s profiles are more likely to survive critical illness.•Arrhythmic 24-h aMT6s rhythms in ICU patients are associated with worse clinical outcomes.•Melatonin rhythm dysregulation may be a novel biomarker of critical illness severity.
Details
- Title: Subtitle
- Disruption of the circadian rhythm of melatonin: A biomarker of critical illness severity
- Creators
- Marie-Anne Melone - Université de Rouen NormandieTaylor C. Becker - University of IowaLinder H. Wendt - University of IowaPatrick Ten Eyck - Institute of Clinical and Translational Science, University of Iowa, Iowa City, IA, USAShruti B. Patel - Loyola University ChicagoJason Poston - University of ChicagoAnne S. Pohlman - University of ChicagoMark Pohlman - New England Sleep Center, Manchester, NH, USAAnnette Miller - University of ChicagoArlet Nedeltcheva - Cook County Health and Hospitals SystemJesse B. Hall - University of ChicagoEve Van Cauter - University of ChicagoJoseph Zabner - University of IowaBrian K. Gehlbach - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Sleep medicine, Vol.110, pp.60-67
- DOI
- 10.1016/j.sleep.2023.07.033
- PMID
- 37541132
- PMCID
- PMC11386949
- NLM abbreviation
- Sleep Med
- ISSN
- 1389-9457
- eISSN
- 1878-5506
- Publisher
- Elsevier B.V
- Grant note
- DOI: 10.13039/100006108, name: National Center for Advancing Translational Sciences, award: UL1TR002537; DOI: 10.13039/100000002, name: National Institutes of Health, award: KL2 TR002536; DOI: 10.13039/100000050, name: National Heart, Lung, and Blood Institute, award: K23HL088020
- Language
- English
- Date published
- 10/01/2023
- Academic Unit
- Neurology; Pulmonary, Critical Care, and Occupational Medicine; Biostatistics; Health, Sport, and Human Physiology ; Internal Medicine; Design Biostat and Ethics
- Record Identifier
- 9984453341502771
Metrics
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