Evaluation of the Acid-Base Status in Patients Admitted to the ICU Due to Severe COVID-19 : Physicochemical versus Traditional Approaches
BACKGROUND: Stewart's approach is known to have better diagnostic accuracy for the identification of metabolic acid-base disturbances compared to traditional methods based either on plasma bicarbonate concentration ([HCO3-]) and anion gap (AG) or on base excess/deficit (BE). This study aimed to identify metabolic acid-base disorders using either Stewart's or traditional approaches in critically ill COVID-19 patients admitted to the ICU, to recognize potential hidden acid-base metabolic abnormalities and to assess the prognostic value of these abnormalities for patient outcome.
METHODS: This was a single-center retrospective study, in which we collected data from patients with severe COVID-19 admitted to the ICU. Electronical files were used to retrieve data for arterial blood gases, serum electrolytes, and proteins and to derive [HCO3-], BE, anion gap (AG), AG adjusted for albumin (AGadj), strong ion difference, strong ion gap (SIG), and SIG corrected for water excess/deficit (SIGcorr). The acid-base status was evaluated in each patient using the BE, [HCO3-], and physicochemical approaches.
RESULTS: We included 185 patients. The physicochemical approach detected more individuals with metabolic acid-base abnormalities than the BE and [HCO3-] approaches (p < 0.001), and at least one acid-base disorder was recognized in most patients. According to the physicochemical method, 170/185 patients (91.4%) had at least one disorder, as opposed to the number of patients identified using the BE 90/186 (48%) and HCO3 62/186 (33%) methods. Regarding the derived acid-base status variables, non-survivors had greater AGadj, (p = 0.013) and SIGcorr (p = 0.035) compared to survivors.
CONCLUSIONS: The identification of hidden acid-base disturbances may provide a detailed understanding of the underlying conditions in patients and of the possible pathophysiological mechanisms implicated. The association of these acid-base abnormalities with mortality provides the opportunity to recognize patients at increased risk of death and support them accordingly.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Journal of personalized medicine - 13(2023), 12 vom: 11. Dez. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Sotiropoulou, Zoi [VerfasserIn] |
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| Links: |
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| Themen: |
Acid–base disorders |
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| Anmerkungen: |
Date Revised 25.12.2023 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.3390/jpm13121700 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM366295861 |
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| 100 | 1 | |a Sotiropoulou, Zoi |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Evaluation of the Acid-Base Status in Patients Admitted to the ICU Due to Severe COVID-19 |b Physicochemical versus Traditional Approaches |
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| 500 | |a Date Revised 25.12.2023 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a BACKGROUND: Stewart's approach is known to have better diagnostic accuracy for the identification of metabolic acid-base disturbances compared to traditional methods based either on plasma bicarbonate concentration ([HCO3-]) and anion gap (AG) or on base excess/deficit (BE). This study aimed to identify metabolic acid-base disorders using either Stewart's or traditional approaches in critically ill COVID-19 patients admitted to the ICU, to recognize potential hidden acid-base metabolic abnormalities and to assess the prognostic value of these abnormalities for patient outcome | ||
| 520 | |a METHODS: This was a single-center retrospective study, in which we collected data from patients with severe COVID-19 admitted to the ICU. Electronical files were used to retrieve data for arterial blood gases, serum electrolytes, and proteins and to derive [HCO3-], BE, anion gap (AG), AG adjusted for albumin (AGadj), strong ion difference, strong ion gap (SIG), and SIG corrected for water excess/deficit (SIGcorr). The acid-base status was evaluated in each patient using the BE, [HCO3-], and physicochemical approaches | ||
| 520 | |a RESULTS: We included 185 patients. The physicochemical approach detected more individuals with metabolic acid-base abnormalities than the BE and [HCO3-] approaches (p < 0.001), and at least one acid-base disorder was recognized in most patients. According to the physicochemical method, 170/185 patients (91.4%) had at least one disorder, as opposed to the number of patients identified using the BE 90/186 (48%) and HCO3 62/186 (33%) methods. Regarding the derived acid-base status variables, non-survivors had greater AGadj, (p = 0.013) and SIGcorr (p = 0.035) compared to survivors | ||
| 520 | |a CONCLUSIONS: The identification of hidden acid-base disturbances may provide a detailed understanding of the underlying conditions in patients and of the possible pathophysiological mechanisms implicated. The association of these acid-base abnormalities with mortality provides the opportunity to recognize patients at increased risk of death and support them accordingly | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a acid–base disorders | |
| 650 | 4 | |a base excess | |
| 650 | 4 | |a intensive care unit | |
| 650 | 4 | |a physicochemical approach | |
| 700 | 1 | |a Antonogiannaki, Elvira Markela |e verfasserin |4 aut | |
| 700 | 1 | |a Koukaki, Evangelia |e verfasserin |4 aut | |
| 700 | 1 | |a Zaneli, Stavroula |e verfasserin |4 aut | |
| 700 | 1 | |a Bakakos, Agamemnon |e verfasserin |4 aut | |
| 700 | 1 | |a Vontetsianos, Angelos |e verfasserin |4 aut | |
| 700 | 1 | |a Anagnostopoulos, Nektarios |e verfasserin |4 aut | |
| 700 | 1 | |a Rovina, Nikoleta |e verfasserin |4 aut | |
| 700 | 1 | |a Loverdos, Konstantinos |e verfasserin |4 aut | |
| 700 | 1 | |a Tripolitsioti, Paraskevi |e verfasserin |4 aut | |
| 700 | 1 | |a Kyriakopoulou, Magdalini |e verfasserin |4 aut | |
| 700 | 1 | |a Pontikis, Konstantinos |e verfasserin |4 aut | |
| 700 | 1 | |a Bakakos, Petros |e verfasserin |4 aut | |
| 700 | 1 | |a Georgopoulos, Dimitrios |e verfasserin |4 aut | |
| 700 | 1 | |a Papaioannou, Andriana I |e verfasserin |4 aut | |
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