. Author manuscript; available in PMC: 2018 Sep 1.

Published in final edited form as: Pharmacotherapy. 2017 Jul 31;37(9):1023–1032. doi: 10.1002/phar.1974

Table 2. Metabolic Pathways and Associated Metabolites That Are Altered in Sepsis.

Metabolic pathway	Sepsis response	Representative metabolites and direction of change
Amino acid metabolism	Increased catabolism of body tissues for energy production	↓ kynurenine, a by-product of tryptophan metabolism found in sepsis survivors, suggests efficient transition to noncatabolic pathways³⁷ ↓ decreased amino acids correlate with bacteremic sepsis^{40, 53, 62} ↑ amino acids in response to effective treatment⁵⁷
Mitochondrial energy metabolism	Increased to meet energy requirement/demand	↑ 3-hydroxybutyrate and acetoacetate (ketone bodies) increase in nonsurvivors suggests compensatory response to decreased ATP⁵¹ ↑ lysophosphatidylcholines³⁷ ↑ acylcarnitines (transport long-chain fatty acids across mitrochondrial membrane) in nonsurvivors suggests defect in free fatty acid metabolism^{42, 44, 48} ↑ linoleic acid in response to effective treatment⁵⁷
Tricarboxylic acid cycle	Utilized substrates for aerobic catabolism	↑ amounts of substrate (citrate, malate, pyruvate, acetate, lactate) in nonsurvivors due to inability to metabolize^{42, 48}
Pentose phosphate pathway	Utilized as alternate pathway for glucose metabolism	↓ THBA, ribitol, and ribonic acid suggest compensatory response to decreased ATP⁴²

ATP = adenosine triphosphate; THBA = 2,3,4-trihydroxybutyric acid.