Endogenous Carboxyhemoglobin Level Variation in COVID-19 and Bacterial Sepsis: A Novel Approach?

Abstract

Background: The increased production of carbon monoxide (CO) in sepsis has been proven, but the blood level variations of carboxyhemoglobin (COHb) as a potential evolutionary parameter of COVID-19 and sepsis/septic shock have yet to be determined. This study aims to evaluate the serum level variation of COHb as a potential evolutionary parameter in COVID-19 critically ill patients and in bacterial sepsis. Materials and method: A prospective and observational study was conducted on two groups of patients: the bacterial sepsis group (n = 52) and the COVID-19 group (n = 52). We followed paraclinical parameters on Day 1 (D1) and Day 5 (D5) of sepsis/ICU admission for COVID-19 patients. Results: D1 of sepsis: statistically significant positive correlations between: COHb values and serum lactate (p = 0.024, r = 0.316), and total bilirubin (p = 0.01, r = 0.359). In D5 of sepsis: a statistically significant positive correlations between: COHb values and procalcitonin (PCT) (p = 0.038, r = 0.402), and total bilirubin (p = 0.023, r = 0.319). D1 of COVID-19 group: COHb levels were statistically significantly positively correlated with C-reactive protein CRP values (p = 0.003, r = 0.407) and with PCT values (p = 0.022, r = 0.324) and statistically significantly negatively correlated with serum lactate values (p = 0.038, r = −0.285). Conclusion: COHb variation could provide rapid information about the outcome of bacterial sepsis/septic shock, having the advantages of a favorable cost-effectiveness ratio, and availability as a point-of-care test.

Is Carboxyhaemoglobin an Effective Bedside Prognostic Tool for Sepsis and Septic Shock Patients?

“…Another study published in 2023 by G. Vadar and E. Ozek studied COHb levels in late-onset sepsis in pre-term neonates and found increased levels of COHb in the beginning of sepsis that decreased in response to antibiotics, but the variation of COHb, when used in conjunction with other sepsis biomarkers, could predict the outcome of sepsis [ 22 ]. Our study found an increase in COHb levels from D1 to D5 in both sepsis and septic shock non-survivors, comparable results to to recent literature [ 13 , 22 ].…”

“…Production of endogenous CO is the result of heme catabolism by heme oxygenase enzymes [ 12 ]. Disruption of heme metabolism and liver dysfunction associated with sepsis leads to an increase of COHb levels mainly due to oxidative stress, hypoxia, cytokines, endotoxins, and inflammatory mediators [ 13 , 20 ]. COHb is a parameter measured frequently in ICU during routine arterial blood gas analysis, an abrupt change of trend in COHb levels could lead the physician to notice a new course of the disease [ 12 ].…”

“…Therefore, COHb levels might be utilized as a bedside prognostic tool to monitor the progression of sepsis and could provide early information regarding the outcome of both bacterial and viral infection [ 13 ].…”

Carboxyhemoglobin Levels in Preterm Neonatal Late-Onset Sepsis: To Predict or Not to Predict

“…There are conflicting results in critically ill adult patients regarding a correlation between serum lactate and COHb in the literature. 28,29 However, we found no correlation between serum lactate and COHb in the present study. In an experimental animal model, intestinal HO-1 expression increased in NEC.…”

“…A total of 154 infants met the inclusion criteria of the study. The LOS group consisted of 77 newborns with an average gestation week and birth weight of 28 (26)(27)(28)(29)(30)(31)(32) weeks and 1030 (720-1745) gr, respectively. The onset time of LOS, calculated as the median, was 19 days in the study group.…”