Correlating arterial blood gas, acid–base and blood pressure abnormalities with outcomes in COVID-19 intensive care patients

Rysz

et al. 2021

Endocrine Connections

Acute systemic diseases, such as severe infections, can lead to electrolyte and acid-base alterations. To study the presence of electrolyte imbalance in severe COVID-19, we investigated the frequency and consequences of changes in electrolyte and acid-base patterns over time. We performed a retrospective cohort study including 406 patients with severe COVID-19. Levels of electrolytes, base excess, pH, serum osmolality and hematocrit, the first two weeks of hospitalization, were collected daily from the laboratory database and clinical data from patients’ medical records. We found that hyponatremia was present in 57% of the patients at admission and hypernatremia in 2%. However, within two weeks of hospitalization 42% of the patients developed hypernatremia, more frequently in critically ill patients. Lower levels of sodium and potassium at admission was associated with need of mechanical ventilation. Decreased pH at admission was associated with both death and need of mechanical ventilation. Hypernatremia in the ICU was combined with rising base excess and a higher pH. In the group without intensive care, potassium levels was significantly lower in the patients with severe hypernatremia. Presence of hypernatremia during the first two weeks of hospitalization was associated with 3.942 (95% CI 2.269–6.851) times higher odds of death. In summary, hypernatremia was common and associated with longer hospital stay and a higher risk of death, suggesting that the dynamics of sodium is an important indicator of severity in COVID-19.

Section: Introductionmentioning

confidence: 99%

Electrolyte and acid-base imbalance in severe COVID-19

Rysz

et al. 2021

Endocrine Connections

“…Previos studies with COVID-19 patients have also reported low pH levels in arterial blood gaz analyses and related this situation to respiratory acidosis caused by lung damage [29,30,31]. Another study in COVID-19 patients in the ICU have shwon that relatively higher arterial blood pH is strongly correlated with survival [32].…”

Section: Discussionmentioning

confidence: 99%

A New Diagnostic Approach to COVID-19 Patients; Co-Evaluation of Clinical Laboratory Findings With Radiological CT Results

Balık¹,

Yücel²,

Sertoğlu³

et al. 2021

Preprint

In this study, it was aimed to combine laboratory data of COVID-19 patients with CT segmentation-volume analysis (CT-SVA) and is the first research on this subject. Patients were divided into two groups according to disease severity as mild/moderate (n = 41) and severe/critical (n = 42). The initial laboratory parameters of the patients at admission like sodium, albumin, CRP, D-dimer, ferritin, fibrinogen, IL-6, procalcitonine, venous blood gas and complete blood count (WBC, lymphocyte, neutrophile, NLR) were recorded and evaluated together with CT-SVA. CT scans of the patients were integrated into ITH Snap Software and damaged tissue volume in ratio to total lung volume was calculated as percent ratio. The results of the study have shown that sodium, CRP, D-dimer, ferritin, fibrinogen, IL-6, procalcitonine, WBC, neutrophile, NLR values were significantly higher at first admission in the severe/critical patient group (p < 0.05), while albumin, lymphocyte and venous blood pH values were significantly lower (p < 0.05). CT-SVA results have shown negatvice correlation with albumin (p = 0.007), while had a positive correlation with CRP (p = 0.036), D-dimer (p < 0.001) ve ferritin (p < 0.001), fibrinogen (p = 0.031), IL-6 (p = 0.001) and procalcitonine (p = 0.009). Evaluation of laboratory parameters together with CT-SVA results will help early identification of cases with a poor prognosis and accelerating intervention.

“…Наличие выраженного алкалоза при поступлении, с низкими цифрами растворенного кислорода, высокой углекислоты лактата у пациентов с новой коронавирусной инфекцией фиксировалось также и в других исследованиях. При этом выраженность исходного алкалоза коррелировала с летальностью [6].…”

Section: обмен клиническим опытомunclassified

“…Исследователями определён предиктор выживаемости -повышенный уровень pH. Средние уровни калия, натрия, лактата, креатинина и мочевины в группах выживших и умерших пациентов не имели статистических различий [6].…”

Section: обмен клиническим опытом оригинальное исследование / Original Researchunclassified

“…Столь быстрое и массивное повреждение структур альвеолокапиллярной мембраны и эндотелия лёгочных сосудов в тяжёлых случаях приводит к низкой эффективности различных стратегий искусственной вентиляции лёгких и зачастую требует экстракорпоральной оксигенации. При этом взаимосвязь между нарастающей выраженностью нарушений газообмена, кислотно-основного состояния (КОС) и водно-электролитного баланса (ВЭБ) и выживаемостью у больных с новой коронавирусной инфекцией была продемонстрирована в ряде работ [6][7][8].…”

unclassified

See 1 more Smart Citation

A new look at the correction of COVID-19-mediated pulmonary gas exchange disorders

Симутис

Boyarinov

Yuriev³

et al. 2021

Kazan Med J

Aim. To assess the effect of meglumine sodium succinate on the effectiveness of basic therapy in correcting gas exchange abnormalities in patients with severe COVID-19 infection complicated by bilateral community-acquired pneumonia. Methods. The analysis of the effectiveness of therapy of 12 patients with a diagnosis of New coronavirus infection COVID-19 (confirmed), severe form U07.1. Complication: bilateral multifocal pneumonia was carried out. The patients were divided into two groups: 7 received, as part of standard therapy, a solution of meglumine sodium succinate in a daily dose of 5 ml/kg during stay in the intensive care unit; 5 patients received a similar volume of Ringer's solution and formed the control group. In the arterial and venous blood of all patients, the indicators of acid-base state and water-electrolyte balance, glycemia and lactatemia were measured at several stages: (1) at admission to the intensive care unit, (2) 24 hours after the start of intensive therapy, (3) after 812 hours, (4) after 24 hours. On the 28th day of observation, mortality, the duration of treatment in the intensive care unit and the incidence of thrombotic complications in the groups were assessed. The Friedman nonparametric hypothesis test was used to assess intragroup dynamics, and the nonparametric Mannhitney U test for intergroup comparisons. Results. In the group of patients who received meglumine sodium succinate, there was a significant decrease in the incidence of thromboembolic events during 28 days of treatment: myocardial ischemia event rate ratio from 0.89 [95% confidence interval (CI) 0.191.16] in the control group to 0.55 (95% CI 0.060.81) in the study group at p=0.043; pulmonary embolism event from 0.50 (95% CI 01.0) in the control group to 0.28 (95% CI 01.0) in the study group at p=0.041. There was also a decrease in the duration of intensive care unit length of stay to 6.11.1 days in the study group versus 8.91.3 days in the control group. Conclusion. Compared with standard infusion therapy, the use of meglumine sodium succinate leads to a faster normalization of ventilation-perfusion ratios in patients with severe coronavirus infection.