A203: The Process of Dying; biological changes towards the end of life

Seamus Coyle1,Aileen Scott1,Amara Nwosu1,Richard Latten1,James Wilson2,Stephen Mason1,Chris Probert2,John Ellershaw1

1Marie Curie Palliative Care Institute, Liverpool, UK,2Institute of Translational Medicine, Liverpool, UK

Presenting date: Monday 2 November
Presenting time: 12.20-13.10

Background

Recognising when someone is in the last days of their life is an ongoing difficulty for clinicians. There are few studies investigating the biological changes during dying and there are no studies investigating biochemical changes during dying.

Aim

To collect urine samples from patients towards the end of life and analyse these using a metabolomic approach

Method

A feasibility study was undertaken to prospectively collect urine from patients at the Marie Curie Hospice. Volatile organic compounds (VOC) were analysed by Gas Chromatography Mass Spectrometry (GC-MS).

Results

128 separate samples from 20 different patients were collected in a 12 week study. The consent rate was 57% (n=33). Seven people died while the study was ongoing and another 4 patients died in the following 4 weeks.

GC-MS analysis identified over 400 metabolites. 90 were detected at significantly different levels in the last weeks and days of life. Of these VOCs, 30 were ketones, 10 alcohols, 9 alkanes and 8 acids. A subgroup analyses of patients who were ‘actively dying’ showed 10 VOCs that were statistically significant. Analyses also suggests that some VOCs appear in the last 3 weeks and the last week of life.

Conclusion

It is possible to prospectively collect biological samples from patients towards the end of life. Research into the biological changes at the end of life could develop a greater understanding of the dying process. This research could have the potential to significantly impact the care future dying patients receive.