Blood acylcarnitine profile alterations and fatty acid metabolism dysregulation associated with severe retinopathy of prematurity in preterm infants.

BACKGROUND: Retinopathy of prematurity (ROP) may be associated with abnormal retinal and systemic metabolic states. This study investigated the relationship between changes in free carnitine and acylcarnitine levels during the first postnatal week and the risk of severe ROP, and further explored their potential value for early risk assessment of severe ROP. METHODS: In this retrospective cohort study, eligible infants underwent ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) testing within the first 7 days after birth. Free carnitine and acylcarnitine levels were compared between the ROP and the control group. RESULTS: A total of 101 preterm infants were included in the ROP group, and 105 preterm infants were included in the control group. Except for 3-hydroxyisovalerylcarnitine (C5OH/C4DC), the levels of acetylcarnitine (C2), propionylcarnitine, glutarylcarnitine (C5DC/C6OH), adipylcarnitine, octenylcarnitine (C8:1), dodecanoylcarnitine, tetradecanoylcarnitine (C14), 3-hydroxytetradecanoylcarnitine, tetradecenoylcarnitine (C14:1), palmitoylcarnitine (C16), 3-hydroxypalmitoylcarnitine (C16OH), hexadecenoylcarnitine (C16:1), 3-hydroxyhexadecenoylcarnitine (C16:1OH), octadecanoylcarnitine (C18), 3-hydroxyoctadecanoylcarnitine, and 3-hydroxyoctadecenoylcarnitine (C18:1OH) were significantly lower in the severe ROP group than in the control group (all P < 0.05). Stepwise multivariable logistic regression retained lower birth weight, lower C16OH levels, higher C5OH/C4DC levels, and lower C2 levels in the final exploratory model for severe ROP. Receiver operating characteristic (ROC) curve analysis showed that the clinical-metabolic combined model, including birth weight, C16OH, C5OH/C4DC, and C2, exhibited a higher area under the curve (AUC). In addition, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis indicated that these differential metabolites were involved in seven metabolic pathways. CONCLUSION: Infants in the ROP group exhibited alterations in the acylcarnitine profile, which may reflect changes in fatty acid metabolism, and these alterations might be associated with severe ROP.