COVID-19 患者酸碱失调的物理化学特征:一项队列研究。

Sergio Pinto de Souza, Juliana R Caldas, Marcelo Barreto Lopes, Marcelo Augusto Duarte Silveira, Fernanda Oliveira Coelho, Igor Oliveira Queiroz, Pedro Domingues Cury, Rogério da Hora Passos
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引用次数: 0

摘要

背景:对2019年冠状病毒病(COVID-19)患者酸碱失衡的描述很少。采用定量酸碱方法进行研究可能会解释传统酸碱分析技术可能忽略的离子分布的微小变化。在 COVID-19 重症患者队列中,我们寻找了代谢性酸中毒代用指标与死亡率、肾透析和住院时间等较差临床结果之间的关联。目的:使用斯图尔特方法描述 COVID-19 重症患者的酸碱紊乱,并将其变量与较差结果联系起来:本研究是一项回顾性队列研究,研究对象是在重症监护室住院超过 4 天、通过鼻拭子聚合酶链反应分析呈阳性和胸部计算机断层扫描观察到典型肺部受累而被诊断为感染严重急性呼吸系统综合征冠状病毒 2 的成年患者。实验室和临床数据均来自电子病历。分类变量的比较采用费雪精确检验。连续数据以中位数和四分位距表示。比较采用 Mann-Whitney U 检验:结果:共对 211 名患者进行了分析。死亡率为 13.7%。总体而言,149 名患者(70.6%)出现碱中毒,28 名患者(13.3%)出现酸中毒,其余 34 名患者(16.2%)的动脉池氢ii正常。在出现酸中毒的患者中,大多数人的表观强离子差(SID)较低(20 名患者,占 9.5%)。在出现碱中毒的人群中,128 名患者(61.0%)的病因与呼吸系统有关。非幸存者年龄较大,合并症较多,夏尔森氏和简化急性生理学评分 3 分较高。我们在这一人群中未发现严重的酸碱失衡。分析的斯图尔特变量(有效 SID、表观 SID、强离子间隙以及白蛋白、乳酸盐、磷和氯化物的影响)在各组之间没有差异:结论:COVID-19 患者普遍存在碱血症。结论:COVID-19 患者普遍存在碱血症,虽然我们没有发现酸碱变量与死亡率之间存在关联,但使用斯图尔特方法可能有助于深入了解这种严重疾病。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Physico-chemical characterization of acid base disorders in patients with COVID-19: A cohort study.

Background: Acid-base imbalance has been poorly described in patients with coronavirus disease 2019 (COVID-19). Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution that may have been overlooked using traditional acid-base analysis techniques. In a cohort of critically ill COVID-19 patients, we looked for an association between metabolic acidosis surrogates and worse clinical outcomes, such as mortality, renal dialysis, and length of hospital stay.

Aim: To describe the acid-base disorders of critically ill COVID-19 patients using Stewart's approach, associating its variables with poor outcomes.

Methods: This study pertained to a retrospective cohort comprised of adult patients who experienced an intensive care unit stay exceeding 4 days and who were diagnosed with severe acute respiratory syndrome coronavirus 2 infection through a positive polymerase chain reaction analysis of a nasal swab and typical pulmonary involvement observed in chest computed tomography scan. Laboratory and clinical data were obtained from electronic records. Categorical variables were compared using Fisher's exact test. Continuous data were presented as median and interquartile range. The Mann-Whitney U test was used for comparisons.

Results: In total, 211 patients were analyzed. The mortality rate was 13.7%. Overall, 149 patients (70.6%) presented with alkalosis, 28 patients (13.3%) had acidosis, and the remaining 34 patients (16.2%) had a normal arterial pondus hydrogenii. Of those presenting with acidosis, most had a low apparent strong ion difference (SID) (20 patients, 9.5%). Within the group with alkalosis, 128 patients (61.0%) had respiratory origin. The non-survivors were older, had more comorbidities, and had higher Charlson's and simplified acute physiology score 3. We did not find severe acid-base imbalance in this population. The analyzed Stewart's variables (effective SID, apparent SID, and strong ion gap and the effect of albumin, lactate, phosphorus, and chloride) were not different between the groups.

Conclusion: Alkalemia is prevalent in COVID-19 patients. Although we did not find an association between acid-base variables and mortality, the use of Stewart's methodology may provide insights into this severe disease.

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