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Bertilacchi MS, Piccarducci R, Celi A, Germelli L, Romei C, Bartholmai B, Barbieri G, Giacomelli C, Martini C. Blood oxygenation state in COVID-19 patients: Unexplored role of 2,3-bisphosphoglycerate. Biomed J 2024:100723. [PMID: 38583585 DOI: 10.1016/j.bj.2024.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/16/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND COVID-19 reduces lung functionality causing a decrease of blood oxygen levels (hypoxemia) often related to a decreased cellular oxygenation (hypoxia). Besides lung injury, other factors are implicated in the regulation of oxygen availability such as pH, partial arterial carbon dioxide tension (PaCO2), temperature, and erythrocytic 2,3-bisphosphoglycerate (2,3-BPG) levels, all factors affecting hemoglobin saturation curve. However, few data are currently available regarding the 2,3-BPG modulation in SARS-CoV-2 affected patients at the hospital admission. MATERIAL AND METHODS Sixty-eight COVID-19 patients were enrolled at hospital admission. The lung involvement was quantified using chest-Computer Tomography (CT) analysed with automatic software (CALIPER). Haemoglobin concentrations, glycemia, and routine analysis were evaluated in the whole blood, while partial arterial oxygen tension (PaO2), PaCO2, pH, and HCO3- were assessed by arterial blood gas analysis. 2,3-BPG levels were assessed by specific immunoenzymatic assays in RBCs. RESULTS A higher percentage of interstitial lung disease (ILD) and vascular pulmonary-related structure (VRS) volume on chest-CT quantified with CALIPER had been found in COVID-19 patients with a worse disease outcome (R = 0.4342; and R = 0.3641, respectively). Furthermore, patients with lower PaO2 showed an imbalanced acid-base equilibrium (pH, p = 0.0208; PaCO2, p = 0.0496) and a higher 2,3-BPG levels (p = 0.0221). The 2,3-BPG levels were also lower in patients with metabolic alkalosis (p = 0.0012 vs. no alkalosis; and p = 0.0383 vs. respiratory alkalosis). CONCLUSIONS Overall, the data reveal a different pattern of activation of blood oxygenation compensatory mechanisms reflecting a different course of the COVID-19 disease specifically focusing on 2,3-BPG modulation.
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Affiliation(s)
| | | | - Alessandro Celi
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, 56126, Italy
| | | | - Chiara Romei
- Department of Radiology, Pisa University Hospital, Pisa, Italy.
| | - Brian Bartholmai
- Division of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Greta Barbieri
- Department of Emergency Medicine Department, Pisa University Hospital, Italy
| | | | - Claudia Martini
- Department of Pharmacy, University of Pisa, 56126, Pisa, Italy
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2
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Rogers SC, Brummet M, Safari Z, Wang Q, Rowden T, Boyer T, Doctor A. COVID-19 impairs oxygen delivery by altering red blood cell hematological, hemorheological, and oxygen transport properties. Front Physiol 2024; 14:1320697. [PMID: 38235386 PMCID: PMC10791868 DOI: 10.3389/fphys.2023.1320697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) is characterized by impaired oxygen (O2) homeostasis, including O2 sensing, uptake, transport/delivery, and consumption. Red blood cells (RBCs) are central to maintaining O2 homeostasis and undergo direct exposure to coronavirus in vivo. We thus hypothesized that COVID-19 alters RBC properties relevant to O2 homeostasis, including the hematological profile, Hb O2 transport characteristics, rheology, and the hypoxic vasodilatory (HVD) reflex. Methods: RBCs from 18 hospitalized COVID-19 subjects and 20 healthy controls were analyzed as follows: (i) clinical hematological parameters (complete blood count; hematology analyzer); (ii) O2 dissociation curves (p50, Hill number, and Bohr plot; Hemox-Analyzer); (iii) rheological properties (osmotic fragility, deformability, and aggregation; laser-assisted optical rotational cell analyzer (LORRCA) ektacytometry); and (iv) vasoactivity (the RBC HVD; vascular ring bioassay). Results: Compared to age- and gender-matched healthy controls, COVID-19 subjects demonstrated 1) significant hematological differences (increased WBC count-with a higher percentage of neutrophils); RBC distribution width (RDW); and reduced hematocrit (HCT), Hb concentration, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC); 2) impaired O2-carrying capacity and O2 capacitance (resulting from anemia) without difference in p50 or Hb-O2 cooperativity; 3) compromised regulation of RBC volume (altered osmotic fragility); 4) reduced RBC deformability; 5) accelerated RBC aggregation kinetics; and (6) no change in the RBC HVD reflex. Discussion: When considered collectively, homeostatic compensation for these RBC impairments requires that the cardiac output in the COVID cohort would need to increase by ∼135% to maintain O2 delivery similar to that in the control cohort. Additionally, the COVID-19 disease RBC properties were found to be exaggerated in blood-type O hospitalized COVID-19 subjects compared to blood-type A. These data indicate that altered RBC features in hospitalized COVID-19 subjects burden the cardiovascular system to maintain O2 delivery homeostasis, which appears exaggerated by blood type (more pronounced with blood-type O) and likely plays a role in disease pathogenesis.
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Affiliation(s)
| | | | | | | | | | | | - Allan Doctor
- Divisions of Critical Care Medicine and the Center for Blood Oxygen Transport and Hemostasis, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
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3
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Alay GH, Tatlisuluoglu D, Turan G. Can affinity of hemoglobin to oxygen to be a prognostic marker in critically ill COVID-19 patients? Niger J Clin Pract 2023; 26:731-736. [PMID: 37470645 DOI: 10.4103/njcp.njcp_581_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background This study's objective is to determine the slope of the hemoglobin oxygen dissociation curve in critically ill patients who have COVID-19 along with blood gas measurements and how mortality might be impacted by this circumstance. Aim It has been reported that the hemoglobin oxygen dissociation curve is not different from healthy patients in COVID-19. However, there are insufficient data on the behavior of the curve in patients who require intensive care. Patients and Methods This retrospective study was conducted between 01.03.2021 and 01.07.2021 with patients who were followed up due to COVID-19 in adult intensive care unit. P50 and lactate value obtained from in vitro calculated blood gas analysis. The survival status of the patients was recorded. Results The mean P50 value at the admission of nonsurvivors was significantly higher than survivors. In correlation analysis, a significant positive correlation was seen between P50, mortality, and lactate level at admission. SpO2, PaO2/FiO2 ratio, and length of stay in intensive care unit were significantly negatively correlated with P50 levels. Conclusion A right shift in the hemoglobin oxygen dissociation curve is associated with mortality. Lactate levels were also associated with a right shift. Prospective experimental studies are needed to provide a better understanding of this process.
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Affiliation(s)
- G H Alay
- Intensive Care Unit, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - D Tatlisuluoglu
- Intensive Care Unit, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - G Turan
- Intensive Care Unit, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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4
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Kosenko E, Tikhonova L, Alilova G, Montoliu C. Erythrocytes Functionality in SARS-CoV-2 Infection: Potential Link with Alzheimer's Disease. Int J Mol Sci 2023; 24:5739. [PMID: 36982809 PMCID: PMC10051442 DOI: 10.3390/ijms24065739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a rapidly spreading acute respiratory infection caused by SARS-CoV-2. The pathogenesis of the disease remains unclear. Recently, several hypotheses have emerged to explain the mechanism of interaction between SARS-CoV-2 and erythrocytes, and its negative effect on the oxygen-transport function that depends on erythrocyte metabolism, which is responsible for hemoglobin-oxygen affinity (Hb-O2 affinity). In clinical settings, the modulators of the Hb-O2 affinity are not currently measured to assess tissue oxygenation, thereby providing inadequate evaluation of erythrocyte dysfunction in the integrated oxygen-transport system. To discover more about hypoxemia/hypoxia in COVID-19 patients, this review highlights the need for further investigation of the relationship between biochemical aberrations in erythrocytes and oxygen-transport efficiency. Furthermore, patients with severe COVID-19 experience symptoms similar to Alzheimer's, suggesting that their brains have been altered in ways that increase the likelihood of Alzheimer's. Mindful of the partly assessed role of structural, metabolic abnormalities that underlie erythrocyte dysfunction in the pathophysiology of Alzheimer's disease (AD), we further summarize the available data showing that COVID-19 neurocognitive impairments most probably share similar patterns with known mechanisms of brain dysfunctions in AD. Identification of parameters responsible for erythrocyte function that vary under SARS-CoV-2 may contribute to the search for additional components of progressive and irreversible failure in the integrated oxygen-transport system leading to tissue hypoperfusion. This is particularly relevant for the older generation who experience age-related disorders of erythrocyte metabolism and are prone to AD, and provide an opportunity for new personalized therapies to control this deadly infection.
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Affiliation(s)
- Elena Kosenko
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Lyudmila Tikhonova
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Gubidat Alilova
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Carmina Montoliu
- Hospital Clinico Research Foundation, INCLIVA Health Research Institute, 46010 Valencia, Spain
- Pathology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
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5
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Bergamaschi G, Barteselli C, Del Rio V, Borrelli de Andreis F, Pellegrino I, Mengoli C, Miceli E, Colaneri M, Zuccaro V, Di Stefano M, Bruno R, Di Sabatino A, Achilli G, Alimenti E, Alunno G, Antoci V, Aprile M, Argelli A, Aronico N, Ballesio A, Bellini G, Berbenni A, Bertolino G, Bianchi PI, Biserni S, Bonfichi A, Bosoni T, Brattoli M, Calabretta F, Callisti M, Cambiè G, Canta R, Canu P, Cebrelli C, Cecco A, Cicalini C, Clemente M, Clerici L, Codega S, Conca F, Coppola L, Costanzo F, Cremonte ME, Cresci R, Delliponti M, Del Rio V, Delogu C, Derosa G, Dionisi D, Di Terlizzi F, Dota M, Falaschi F, Fazzino E, Ferrami L, Ferrara S, Ferrari MG, Ferruccio N, Freddi G, Frenna C, Frigerio C, Fumoso F, Fusco A, Galeazzo A, Gaspari V, Gentile A, Giangreco A, Gori G, Grandi G, Gregorio V, Grimaldi P, Italia A, Lapia F, Latorre MA, Lenti MV, Lepore F, Lobello A, Lovati E, Lucotti PC, Lusetti F, Maimaris S, Mambella J, Martignoni A, Melazzini F, Mercanti C, Merli S, Moltisanti GC, Monti ME, Morbegno L, Mordà F, Mugellini A, Muggia C, Muscia R, Nardone A, Padovini L, Palumbo I, Parisi IM, Pecci A, Peroo GP, Petrucci C, Pieresca C, Pino G, Pitotti L, Poma S, Preti PS, Quadrelli A, Rascaroli A, Rigano G, Rossi CM, Rotola G, Ruggeri D, Russo MC, Sabatini U, Saglio S, Santacroce G, Savioli G, Savioli J, Scalia SS, Scalvini D, Shoval Y, Soffiantini C, Soriano S, Spadaro D, Staniscia A, Stefani D, Vai F, Varallo M, Vernero M. Impaired respiratory function reduces haemoglobin oxygen affinity in COVID-19. Br J Haematol 2023; 200:e44-e47. [PMID: 36572525 PMCID: PMC9880731 DOI: 10.1111/bjh.18620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/21/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Gaetano Bergamaschi
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Barteselli
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Pavia, Italy
| | - Virginia Del Rio
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Pavia, Italy
| | - Federica Borrelli de Andreis
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Pavia, Italy
| | - Ivan Pellegrino
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Pavia, Italy
| | - Caterina Mengoli
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuela Miceli
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Colaneri
- Division of Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical Surgical Diagnostic & Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Valentina Zuccaro
- Division of Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele Di Stefano
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Division of Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical Surgical Diagnostic & Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Pavia, Italy
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6
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Böning D, Kuebler WM, Vogel D, Bloch W. The oxygen dissociation curve of blood in COVID-19-An update. Front Med (Lausanne) 2023; 10:1098547. [PMID: 36923010 PMCID: PMC10008909 DOI: 10.3389/fmed.2023.1098547] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/03/2023] [Indexed: 03/02/2023] Open
Abstract
An impressive effect of the infection with SARS-Co-19 is the impairment of oxygen uptake due to lung injury. The reduced oxygen diffusion may potentially be counteracted by an increase in oxygen affinity of hemoglobin. However, hypoxia and anemia associated with COVID-19 usually decrease oxygen affinity due to a rise in [2,3-bisphosphoglycerate]. As such, COVID-19 related changes in the oxygen dissociation curve may be critical for oxygen uptake and supply, but are hard to predict. A Pubmed search lists 14 publications on oxygen affinity in COVID-19. While some investigations show no changes, three large studies found an increased affinity that was related to a good prognosis. Exact causes remain unknown. The cause of the associated anemia in COVID-19 is under discussion. Erythrocytes with structural alterations of membrane and cytoskeleton have been observed, and virus binding to Band 3 and also to ACE2 receptors in erythroblasts has been proposed. COVID-19 presentation is moderate in many subjects suffering from sickle cell disease. A possible explanation is that COVID-19 counteracts the unfavorable large right shift of the oxygen dissociation curve in these patients. Under discussion for therapy are mainly affinity-increasing drugs.
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Affiliation(s)
- Dieter Böning
- Institute of Physiology, Charité Medical University of Berlin, Berlin, Germany
| | - Wolfgang M. Kuebler
- Institute of Physiology, Charité Medical University of Berlin, Berlin, Germany
| | - Dominik Vogel
- Klinik für Interdisziplinäre Intensivmedizin, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
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7
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Philip C, David A, Mathew SK, Sunny S, Kumar K V, Jacob L, Mathew L, Kumar S, Chandy G. The Predictive Score for Patients Hospitalized With COVID-19 in Resource-Limited Settings. Cureus 2022; 14:e30373. [PMID: 36407264 PMCID: PMC9671202 DOI: 10.7759/cureus.30373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Background and aims The second wave of coronavirus disease 2019 (COVID-19) has been devastating in India and many developing countries. The mortality reported has been 40% higher than in the first wave, overwhelming the nation's health infrastructure. Despite a better understanding of the disease and established treatment protocols including steroids and heparin, the second wave was disastrous. Subsequent waves have the potential to further cripple healthcare deliveries, also affecting non-COVID-19 care across many developing economies. It is then important to identify and triage high-risk patients to best use the limited resources. Routine tests such as neutrophil and monocyte counts have been identified but have not been successfully validated uniformly, and their utility is still being understood in COVID-19. Various predictive models that are available require online resources and calculators and additionally await validation across all populations. These, although useful, might not be available or accessible across all institutions. It is then important to identify easy-to-use scores that utilize tests done routinely. In identifying with this goal, we did a retrospective review of the institutional database to identify potential predictors of intensive care unit (ICU) admission and mortality in patients hospitalized during the second wave who accessed healthcare at our academic setup. Results Three predictors of mortality and four predictors of ICU admission were identified. Absolute neutrophil count was a common predictor of both ICU admission and mortality but with two separate cut points. An absolute neutrophil count of >4,200 predicted need for ICU admission (odds ratio (OR): 3.1 (95% confidence interval (CI): 2.0, 4.8)), and >7,200 predicted mortality (adjusted OR: 4.2 (95% CI: 1.9, 9.4)). We observed that a blood urea level greater than 45 was predictive of needing ICU care (adjusted OR: 8.0 (95% CI: 3.7, 17.6)). In our dataset, serum ferritin of >500 was predictive of ICU admission (adjusted OR: 2.7 (95% CI: 1.2, 5.9)). We noted a right shift of partial pressure (p50 is the oxygen tension at which hemoglobin is 50% saturated) (p50c) in SARS-CoV-2 as a predictor of ICU care (OR: 2.6 (95% CI: 1.7, 3.9)) when partial pressure is >26.5. In our analysis, a serum protein of less than 7 g/dL (OR: 2.8 (95% CI: 1.7, 4.4)) was a predictive variable for ICU admission. An LDH value of >675 was predictive of severity with a need for ICU admission (OR: 9.2 (95% CI: 5.4, 15.5)) in our series. We then assigned a score to each of the predictive variables based on the adjusted odds ratio. Conclusion We identified a set of easy-to-use predictive variables and scores to recognize the subset of patients hospitalized with COVID-19 with the highest risk of death or clinical worsening requiring ICU care.
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Affiliation(s)
- Chepsy Philip
- Clinical Hematology and Bone Marrow Transplant, COVID-19 Research Group, Believers Church Medical College Hospital, Thiruvalla, IND
| | - Alice David
- Medical Research, COVID-19 Research Group, Believers Church Medical College Hospital, Thiruvalla, IND
| | - S K Mathew
- Internal Medicine, Believers Church Medical College Hospital, Thiruvalla, IND
| | - Sanjo Sunny
- Intensive Care Unit, Believers Church Medical College Hospital, Thiruvalla, IND
| | - Vijaya Kumar K
- Internal Medicine, Believers Church Medical College Hospital, Thiruvalla, IND
| | - Linda Jacob
- Pharmacology and Therapeutics, COVID-19 Registry Group, Believers Church Medical College Hospital, Thiruvalla, IND
| | - Luke Mathew
- Pulmonary Medicine, COVID-19 Registry Group, Believers Church Medical College Hospital, Thiruvalla, IND
| | - Suresh Kumar
- Pediatric Cardiology, COVID-19 Research Group, Believers Church Medical College Hospital, Thiruvalla, IND
| | - George Chandy
- Gastroenterology and Hepatology, Believers Church Medical College Hospital, Thiruvalla, IND
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8
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Shahidi S, Vahdat S, Atapour A, Reisizadeh S, Soltaninejad F, Maghami-Mehr A. The clinical course and risk factors in COVID-19 patients with acute kidney injury. J Family Med Prim Care 2022; 11:6183-6189. [PMID: 36618164 PMCID: PMC9810939 DOI: 10.4103/jfmpc.jfmpc_231_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/28/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Abstract
Background Acute kidney injury (AKI) has the most prevalent complications in COVID-19 patients. A variety of factors is involved in the disease progression and its associated outcomes. The present study aimed at both examining the correlated clinical features of COVID-19 disease and AKI and evaluating its clinical outcomes. Materials and Methods In the present retrospective study, 102 COVID-19 patients that encountered AKI were enrolled and categorized into three AKI stages. Basic and clinical characteristics, clinical signs and symptoms, laboratory and imaging findings, and treatment approaches were examined. Then, clinical outcomes as well as the factors associated with the mortality of patients were evaluated. Results Diabetes was the only significant clinical characteristic among the patients (P = 0.004). An increasing trend was observed for neutrophil-to-lymphocyte ratio (P = 0.027) and potassium (K) (P = 0.006), and a decreasing trend was seen for hemoglobin (P < 0.001), albumin (P = 0.005), and calcium (P < 0.001) factors at higher stages of AKI. Secondary infection (P = 0.019) and hypoproteinemia (P = 0.018) were the most significant clinical outcomes. Chronic obstructive lung disease (OR = 1.362, P = 0.007), renal replacement therapy (OR = 2.067, P = 0.005), lung consolidation (OR = 0.722, P = 0.032), and bilateral pulmonary infiltration (OR = 4.793, P = 0.002) were the factors associated with mortality rate of COVID-19 patients with AKI. Conclusion AKI, as an important complication of COVID-19, that can predict the higher mortality rate as well as the laboratory and clinical characteristics should receive more due consideration in order to employ proper preventive or supportive treatment approaches that are the pivotal key to reduce the mortality rate in target patients.
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Affiliation(s)
- Shahrzad Shahidi
- Department of Nephrology, Isfahan Kidney Diseases Research Center, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Vahdat
- Department of Nephrology, Isfahan Kidney Diseases Research Center, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Sahar Vahdat, Assistant Professor of Nephrology, Isfahan Kidney Diseases Research Center, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Abdolamir Atapour
- Department of Nephrology, Isfahan Kidney Diseases Research Center, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Reisizadeh
- Department of Internal Medicine, Isfahan Kidney Diseases Research Center, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forogh Soltaninejad
- Associate Professor of Pulmonary Diseases, Isfahan Kidney Diseases Research Center, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Harutyunyan G, Benítez Bermejo RI, Harutyunyan V, Harutyunyan G, Sánchez Gimeno A, Cherkezyan A, Petrosyan S, Gnuni A, Soghomonyan S. Hypoxaemia in the early stage of COVID-19: prevalence of physical or biochemical factors? Eur Respir Rev 2022; 31:31/165/220138. [PMID: 36130788 PMCID: PMC9724909 DOI: 10.1183/16000617.0138-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 12/14/2022] Open
Abstract
We read with interest the reply from Busanaet al. [1] to our correspondence [2]. We fully agree with the authors and with the cited references [3–6] stating that the affinity of haemoglobin (Hb) for oxygen (O2) is not affected in the arteries or in the veins of coronavirus disease 2019 (COVID-19) patients. The confusion arises as our concept is based on the biochemical shunt due to the quaternary conformational change of Hb with a temporary decrease of Hb–O2 affinity, which is applicable only to the affected alveolar-capillary bed. The ventilation–perfusion mismatch can't explain the high PaCO2–PETCO2 gap in the setting of COVID-19 induced hypoxaemia and cannot be considered as the sole pathophysiological basis for the treatment in the early stage of COVID-19https://bit.ly/3BKmGxJ
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Affiliation(s)
- Gurgen Harutyunyan
- Hospital 9 de Octubre, Urgency Department, Valencia, Spain,Gurgen Harutyunyan ()
| | | | | | | | | | | | | | - Anatoli Gnuni
- Ministry of Health of the Republic of Armenia, Yerevan, Armenia
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10
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Valle A, Rodriguez J, Camiña F, Rodriguez-Segade M, Ortola JB, Rodriguez-Segade S. The oxyhaemoglobin dissociation curve is generally left-shifted in COVID-19 patients at admission to hospital, and this is associated with lower mortality. Br J Haematol 2022; 199:332-338. [PMID: 35971642 PMCID: PMC9538192 DOI: 10.1111/bjh.18431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 01/08/2023]
Abstract
Lung damage caused by SARS‐Cov‐2 virus results in marked arterial hypoxia, accompanied in many cases by hypocapnia. The literature is inconclusive as to whether these conditions induce alteration of the affinity of haemoglobin for oxygen. We studied the oxyhaemoglobin dissociation curves (ODCs) of 517 patients hospitalized with coronavirus disease 2019 (COVID‐19) for whom arterial blood gas analysis (BGA) was performed upon hospitalization (i.e., before treatment). With respect to a conventional normal p50 (pO2 at 50% saturation of haemoglobin) of 27 mmHg, 76% had a lower standardized p50 (p50s) and 85% a lower in vivo p50 (p50i). In a 33‐patient subgroup with follow‐up BGAs after 3, 6, 9, 12, 15 and 18 days' treatment, p50s and p50i exhibited statistically significant differences between baseline values and values recorded at all these time points. The 30‐day Kaplan–Meier survival curves of COVID‐19 patients stratified by p50i level show a higher probability of survival among patients who at admission had p50 values below 27 mmHg (p = 0.012). Whether the observed alteration of the affinity of haemoglobin for oxygen in COVID‐19 patients is a direct or indirect effect of the virus on haemoglobin is unknown.
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Affiliation(s)
- Andrea Valle
- Clinical Biochemistry Laboratory of University Hospital Complex, Santiago de Compostela. Travesía de la Choupana s/n, Santiago de Compostela, Spain
| | - Javier Rodriguez
- Clinical Biochemistry Laboratory of University Hospital Complex, Santiago de Compostela. Travesía de la Choupana s/n, Santiago de Compostela, Spain.,Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Félix Camiña
- Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel Rodriguez-Segade
- Structural Mechanics Group. ETS Caminos Canales y Puertos. Universidade da Coruña. Campus de Elviña. 15071-, A Coruña, Spain
| | - Juan B Ortola
- Clinical Biochemistry Laboratory of University Hospital Complex, Santiago de Compostela. Travesía de la Choupana s/n, Santiago de Compostela, Spain
| | - Santiago Rodriguez-Segade
- Clinical Biochemistry Laboratory of University Hospital Complex, Santiago de Compostela. Travesía de la Choupana s/n, Santiago de Compostela, Spain.,Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, Santiago de Compostela, Spain
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11
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Busana M, Camporota L, Gattinoni L. Hypoxaemia in COVID-19: many pieces to a complex puzzle. Eur Respir Rev 2022; 31:31/164/220090. [PMID: 35768129 DOI: 10.1183/16000617.0090-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Mattia Busana
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Luigi Camporota
- Dept of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Luciano Gattinoni
- Dept of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
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12
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Gubarev YA, Lebedeva NS, Yurina ES, Mamardashvili GM, Zaitceva SV, Zdanovich SA, Koifman OI. Prospects for the use of macrocyclic photosensitizers for inactivation of SARS-CoV-2: selection of compounds leaders based on the molecular docking data. J Biomol Struct Dyn 2022:1-10. [DOI: 10.1080/07391102.2022.2079562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yury A. Gubarev
- G. A. Krestov Institute of Solution Chemistry, Russian Academy of Sciences, Ivanovo, Russia
| | - Natalia Sh. Lebedeva
- G. A. Krestov Institute of Solution Chemistry, Russian Academy of Sciences, Ivanovo, Russia
| | - Elena S. Yurina
- G. A. Krestov Institute of Solution Chemistry, Russian Academy of Sciences, Ivanovo, Russia
| | | | - Svetlana V. Zaitceva
- G. A. Krestov Institute of Solution Chemistry, Russian Academy of Sciences, Ivanovo, Russia
| | - Sergey A. Zdanovich
- G. A. Krestov Institute of Solution Chemistry, Russian Academy of Sciences, Ivanovo, Russia
| | - Oskar I. Koifman
- G. A. Krestov Institute of Solution Chemistry, Russian Academy of Sciences, Ivanovo, Russia
- Ivanovo State University of Chemistry and Technology, Ivanovo, Russia
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13
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Plummer NR, Fogarty A, Shaw D, Card T, West J, Crooks C. Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection. Respir Med 2022; 197:106858. [PMID: 35490510 PMCID: PMC9047547 DOI: 10.1016/j.rmed.2022.106858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/08/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022]
Abstract
Background Methods Results Conclusions
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14
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Temporal Changes in the Oxyhemoglobin Dissociation Curve of Critically Ill COVID-19 Patients. J Clin Med 2022; 11:jcm11030788. [PMID: 35160240 PMCID: PMC8836951 DOI: 10.3390/jcm11030788] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023] Open
Abstract
Critical COVID-19 is a life-threatening disease characterized by severe hypoxemia with complex pathophysiological mechanisms that are not yet completely understood. A pathological shift in the oxyhemoglobin curve (ODC) was previously described through the analysis of p50, intended as the oxygen tension at which hemoglobin is saturated by oxygen at 50%. The aim of this study was to analyze Hb-O2 affinity features over time in a cohort of critically ill COVID-19 patients, through the analysis of ODC p50 behavior. A retrospective analysis was performed; through multiple arterial blood gas (ABG) analyses, each p50 was calculated and normalized according to PaCO2, pH and temperature; patients' p50 evolution over time was reported, comparing the first 3 days (early p50s) with the last 3 days (late p50s) of ICU stay. A total of 3514 ABG analyses of 32 consecutive patients were analyzed. The majority of patients presented a left shift over time (p = 0.03). A difference between early p50s and late p50s was found (20.63 ± 2.1 vs. 18.68 ± 3.3 mmHg, p = 0.03); median p50 of deceased patients showed more right shifts than those of alive patients (24.1 vs. 18.45 mmHg, p = 0.01). One-way ANOVA revealed a p50 variance greater in the early p50s (σ2 = 8.6) than in the late p50s (σ2 = 3.84), associated with a reduction over time (p < 0.001). Comparing the Hb-O2 affinity in critically ill COVID-19 patients between ICU admission and ICU discharge, a temporal shift in the ODC was observed.
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15
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Cavezzi A, Menicagli R, Troiani E, Corrao S. COVID-19, Cation Dysmetabolism, Sialic Acid, CD147, ACE2, Viroporins, Hepcidin and Ferroptosis: A Possible Unifying Hypothesis. F1000Res 2022; 11:102. [PMID: 35340277 PMCID: PMC8921693 DOI: 10.12688/f1000research.108667.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 08/26/2024] Open
Abstract
Background: iron and calcium dysmetabolism, with hyperferritinemia, hypoferremia, hypocalcemia and anemia have been documented in the majority of COVID-19 patients at later/worse stages. Furthermore, complementary to ACE2, both sialic acid (SA) molecules and CD147 proved relevant host receptors for SARS-CoV-2 entry, which explains the viral attack to multiple types of cells, including erythrocytes, endothelium and neural tissue. Several authors advocated that cell ferroptosis may be the core and final cell degenerative mechanism. Methods: a literature research was performed in several scientific search engines, such as PubMed Central, Cochrane Library, Chemical Abstract Service. More than 500 articles were retrieved until mid-December 2021, to highlight the available evidence about the investigated issues. Results: based on COVID-19 literature data, we have highlighted a few pathophysiological mechanisms, associated with virus-based cation dysmetabolism, multi-organ attack, mitochondria degeneration and ferroptosis. Our suggested elucidated pathological sequence is: a) spike protein subunit S1 docking with sialylated membrane glycoproteins/receptors (ACE2, CD147), and S2 subunit fusion with the lipid layer; b) cell membrane morpho-functional changes due to the consequent electro-chemical variations and viroporin action, which induce an altered ion channel function and intracellular cation accumulation; c) additional intracellular iron concentration due to a deregulated hepcidin-ferroportin axis, with higher hepcidin levels. Viral invasion may also affect erythrocytes/erythroid precursors, endothelial cells and macrophages, through SA and CD147 receptors, with relative hemoglobin and iron/calcium dysmetabolism. AB0 blood group, hemochromatosis, or environmental elements may represent possible factors which affect individual susceptibility to COVID-19. Conclusions: our literature analysis confirms the combined role of SA molecules, ACE2, CD147, viroporins and hepcidin in determining the cation dysmetabolism and final ferroptosis in the cells infected by SARS-CoV-2. The altered ion channels and electrochemical gradients of the cell membrane have a pivotal role in the virus entry and cell dysmetabolism, with subsequent multi-organ immune-inflammatory degeneration and erythrocyte/hemoglobin alterations.
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Affiliation(s)
- Attilio Cavezzi
- Eurocenter Venalinfa, San Benedetto del Tronto, AP, 63074, Italy
| | | | - Emidio Troiani
- Cardiology Unit, Social Security Institute, State Hospital, Cailungo, 47893, San Marino
| | - Salvatore Corrao
- Department of Clinical Medicine, Internal Medicine Division,, ARNAS Civico Di Cristina Benfratelli Hospital Trust, Palermo, Italy
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16
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Cavezzi A, Menicagli R, Troiani E, Corrao S. COVID-19, Cation Dysmetabolism, Sialic Acid, CD147, ACE2, Viroporins, Hepcidin and Ferroptosis: A Possible Unifying Hypothesis. F1000Res 2022; 11:102. [PMID: 35340277 PMCID: PMC8921693 DOI: 10.12688/f1000research.108667.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background: iron and calcium dysmetabolism, with hyperferritinemia, hypoferremia, hypocalcemia and anemia have been documented in the majority of COVID-19 patients at later/worse stages. Furthermore, complementary to ACE2, both sialic acid (SA) molecules and CD147 proved relevant host receptors for SARS-CoV-2 entry, which explains the viral attack to multiple types of cells, including erythrocytes, endothelium and neural tissue. Several authors advocated that cell ferroptosis may be the core and final cell degenerative mechanism. Methods: a literature research was performed in several scientific search engines, such as PubMed Central, Cochrane Library, Chemical Abstract Service. More than 500 articles were retrieved until mid-December 2021, to highlight the available evidence about the investigated issues. Results: based on COVID-19 literature data, we have highlighted a few pathophysiological mechanisms, associated with virus-based cation dysmetabolism, multi-organ attack, mitochondria degeneration and ferroptosis. Our suggested elucidated pathological sequence is: a) spike protein subunit S1 docking with sialylated membrane glycoproteins/receptors (ACE2, CD147), and S2 subunit fusion with the lipid layer; b) cell membrane morpho-functional changes due to the consequent electro-chemical variations and viroporin action, which induce an altered ion channel function and intracellular cation accumulation; c) additional intracellular iron concentration due to a deregulated hepcidin-ferroportin axis, with higher hepcidin levels. Viral invasion may also affect erythrocytes/erythroid precursors, endothelial cells and macrophages, through SA and CD147 receptors, with relative hemoglobin and iron/calcium dysmetabolism. AB0 blood group, hemochromatosis, or environmental elements may represent possible factors which affect individual susceptibility to COVID-19. Conclusions: our literature analysis confirms the combined role of SA molecules, ACE2, CD147, viroporins and hepcidin in determining the cation dysmetabolism and final ferroptosis in the cells infected by SARS-CoV-2. The altered ion channels and electrochemical gradients of the cell membrane have a pivotal role in the virus entry and cell dysmetabolism, with subsequent multi-organ immune-inflammatory degeneration and erythrocyte/hemoglobin alterations.
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Affiliation(s)
- Attilio Cavezzi
- Eurocenter Venalinfa, San Benedetto del Tronto, AP, 63074, Italy
| | | | - Emidio Troiani
- Cardiology Unit, Social Security Institute, State Hospital, Cailungo, 47893, San Marino
| | - Salvatore Corrao
- Department of Clinical Medicine, Internal Medicine Division,, ARNAS Civico Di Cristina Benfratelli Hospital Trust, Palermo, Italy
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17
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Rando E, Oliva A, Cancelli F, D'Agostino C, Savelloni G, Ciardi MR, Ajassa C, Siccardi G, Galardo G, Mastroianni CM. Clinical characteristics and risk factors for mortality in COVID-19 patients during the first wave of the COVID-19 pandemic in Rome, Italy: a single-center retrospective study. LE INFEZIONI IN MEDICINA 2022; 31:49-54. [PMID: 36908386 PMCID: PMC9994829 DOI: 10.53854/liim-3101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/27/2023] [Indexed: 03/07/2023]
Abstract
Background Since the beginning of 2020, the SARS-CoV-2 pandemic has become a serious public health problem. Numerous studies have highlighted the main clinical features of COVID-19, mainly the huge heterogeneity of the clinical manifestations that can vary from asymptomatic infection to serious viral pneumonia with a high mortality rate. The aim of this study was to analyze retrospectively the clinical characteristics and assess the risk factors for mortality in an Italian cohort of patients with COVID-19. Methods Retrospective analysis including patients with COVID-19 admitted to the Infectious Diseases wards of Azienda Ospedaliera Universitaria Policlinico "Umberto 1", Rome, from March 2020 to May 2020. The data were part of an electronic anonymous web-based database processed by SIMIT (Italian Society of Infectious and Tropical Diseases). Results 258 patients were included in the analysis, and 34 (13.2%) died. The median age was 62 (IQR, 52-74), 106 (40%) were women, and 152 (60%) were males, 172 (66.7%) had at least one co-morbidity. The most common signs and symptoms were: fever [221 (85.6%)], cough [135 (52.3%)], and dyspnea [133 (51.5%)]. The PaO2/FiO2 ratio was often altered [352 (IQR, 308-424)]. Lymphopenia [lymphocyte counts, 875/μL (IQR, 640-1250)] and high levels of D-dimer [mg/dL, 874 (IQR, 484-1518)] were found. Non-survivors were older than survivors [median age, 74 (IQR, 67-85)] vs. 61 (QR, 51-72)], mostly men [25 (73.5%)] and more frequently with more than 2 comorbidities [21 (61.8%) vs. 94 (42.1%)]. In the multiple logistic regression model, the variables associated with in-hospital mortality were age [OR, 3.65 (95% CI, 1.22-10.89)], male gender [OR, 2.99 (95% CI, 1.18-7.54)], blood urea [OR, 2.76 (95% CI, 1.20-6.35)] and a low PaO2/FiO2 ratio [OR, 0.28 (95% CI, 0.12-0.62)]. Conclusion The mortality rate in COVID-19 was 13,2%. The risk factors associated with in-hospital mortality were advanced age, male sex, increased blood urea, and the PaO2/FiO2 ratio reduction.
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Affiliation(s)
- Emanuele Rando
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Francesca Cancelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Claudia D'Agostino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giulia Savelloni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guido Siccardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Gioacchino Galardo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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18
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Pascual-Guàrdia S, Ferrer A, Díaz Ó, Caguana AO, Tejedor E, Bellido-Calduch S, Rodríguez-Chiaradia DA, Gea J. Absence of relevant clinical effects of SARS-COV-2 on the affinity of hemoglobin for O 2 in patients with COVID-19. Arch Bronconeumol 2021; 57:757-763. [PMID: 34720331 PMCID: PMC8536567 DOI: 10.1016/j.arbr.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/17/2021] [Indexed: 12/14/2022]
Abstract
Pulmonary involvement in COVID-19 is frequently associated with alterations in oxygenation. The arterial partial pressure of oxygen (PaO2) is the most clinically used variable to assess such oxygenation, since it decisively influences the oxygen transported by hemoglobin (expressed by its percentage of saturation, SaO2). However, two recent studies conducted respectively in silico and using omic techniques in red blood cells of COVID-19 patients have suggested that SARS-CoV-2 could decrease the affinity of oxygen for the hemoglobin (which would imply that PaO2 would overestimate SaO2), and also reduce the amount of this carrier molecule. OBJECTIVE To evaluate this hypothesis in blood samples from COVID-19 patients. METHODS Blood gases of all COVID-19 patients performed in our laboratory in two months were included, as well as those from two control groups: synchronous patients with negative PCR for SARS-CoV-2 (SCG) and a historical group (HCG). Both SaO2 and venous saturations (SvO2) measured by cooximetry (COX) were compared separately with those calculated using the Kelman (K), Severinghaus (SV) and Siggaard-Andersen (SA) equations in each group. RESULTS Measured and calculated SaO2 and SvO2 were practically equivalent in all groups. Intraclass correlation coefficients (ICC) for SaO2 in COVID-19 were 0.993 for COX-K and 0.992 for both COX-SV and COX-SA; being 0.995 for SvO2 for either COX-K, COX-SV or COX-SA. Hemoglobin and ferritin were slightly higher in COVID-19 compared to SCG and HCG (hemoglobin, p < 0.001 for both; ferritin, p < 0.05 for SCG and p < 0.001 for HCG). CONCLUSION Under clinical conditions SARS-CoV-2 does not have an appreciable influence on the affinity of oxygen for the hemoglobin, nor on the levels of this carrier molecule. Therefore, PaO2 is a good marker of blood oxygenation also in COVID-19.
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Affiliation(s)
- Sergi Pascual-Guàrdia
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
| | - Antoni Ferrer
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
| | - Óscar Díaz
- Laboratorio de Referencia de Cataluña, El Prat de Llobregat, Spain
| | - Antonio O Caguana
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
| | - Elvira Tejedor
- Laboratorio de Referencia de Cataluña, El Prat de Llobregat, Spain
| | - Salomé Bellido-Calduch
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
| | - Diego A Rodríguez-Chiaradia
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
| | - Joaquim Gea
- Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, BRN, Barcelona, Spain
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19
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Alayash AI. The Impact of COVID-19 Infection on Oxygen Homeostasis: A Molecular Perspective. Front Physiol 2021; 12:711976. [PMID: 34690793 PMCID: PMC8532809 DOI: 10.3389/fphys.2021.711976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
The novel coronavirus (2019-nCoV/SARS-CoV-2) causes respiratory symptoms including a substantial pulmonary dysfunction with worsening arterial hypoxemia (low blood oxygenation), eventually leading to acute respiratory distress syndrome (ARDS). The impact of the viral infection on blood oxygenation and other elements of oxygen homeostasis, such as oxygen sensing and respiratory mitochondrial mechanisms, are not well understood. As a step toward understanding these mechanisms in the context of COVID-19, recent experiments revealed contradictory data on the impact of COVID-19 infection on red blood cells (RBCs) oxygenation parameters. However, structural protein damage and membrane lipid remodeling in RBCs from COVID-19 patients that may impact RBC function have been reported. Moreover, COVID-19 infection could potentially disrupt one, if not all, of the other major pathways of homeostasis. Understanding the nature of the crosstalk among normal homeostatic pathways; oxygen carrying, oxygen sensing (i.e., hypoxia inducible factor, HIF) proteins, and the mitochondrial respiratory machinery may provide a target for therapeutic interventions.
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Affiliation(s)
- Abdu I Alayash
- Division of Blood and Devices (DBCD), United States Food and Drug Administration, Silver Spring, MD, United States
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20
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Maher P, Zafar H, Mathews K. Oxyhemoglobin concentrations do not support hemoglobinopathy in COVID-19. Respir Med 2021; 187:106597. [PMID: 34481306 PMCID: PMC8405232 DOI: 10.1016/j.rmed.2021.106597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022]
Abstract
Based on computerized modeling studies, it has been postulated that the severe hypoxemia in COVID-19 may result from impaired oxygen carrying capacity on hemoglobin. Standard pulse oximetry may not detect hypoxemia resulting from hemoglobinopathy, therefore hemoglobin co-oximetry is needed to evaluate this divergence. In a clinical data analysis of a multicenter cohort of hospitalized patients with COVID-19, we found a minimal effect, less than 1%, on the correlation between oxyhemoglobin concentration and predicted oxygen saturation in the presence of COVID-19 infection. This effect is unlikely to explain the clinically significant hypoxia in COVID-19 patients.
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Affiliation(s)
- Patrick Maher
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Hamna Zafar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kusum Mathews
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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21
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Böning D, Kuebler WM, Bloch W. The oxygen dissociation curve of blood in COVID-19. Am J Physiol Lung Cell Mol Physiol 2021; 321:L349-L357. [PMID: 33978488 PMCID: PMC8384474 DOI: 10.1152/ajplung.00079.2021] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022] Open
Abstract
COVID-19 hinders oxygen transport to the consuming tissues by at least two mechanisms: In the injured lung, saturation of hemoglobin is compromised, and in the tissues, an associated anemia reduces the volume of delivered oxygen. For the first problem, increased hemoglobin oxygen affinity [left shift of the oxygen dissociation curve (ODC)] is of advantage, for the second, however, the contrary is the case. Indeed a right shift of the ODC has been found in former studies for anemia caused by reduced cell production or hemolysis. This resulted from increased 2,3-bisphosphoglycerate (2,3-BPG) concentration. In three investigations in COVID-19, however, no change of hemoglobin affinity was detected in spite of probably high [2,3-BPG]. The most plausible cause for this finding is formation of methemoglobin (MetHb), which increases the oxygen affinity and thus apparently compensates for the 2,3-BPG effect. However, this "useful effect" is cancelled by the concomitant reduction of functional hemoglobin. In the largest study on COVID-19, even a clear left shift of the ODC was detected when calculated from measurements in fresh blood rather than after equilibration with gases outside the body. This additional "in vivo" left shift possibly results from various factors, e.g., concentration changes of Cl-, 2,3-BPG, ATP, lactate, nitrocompounds, glutathione, glutamate, because of time delay between blood sampling and end of equilibration, or enlarged distribution space including interstitial fluid and is useful for O2 uptake in the lungs. Under discussion for therapy are the affinity-increasing 5-hydroxymethyl-2-furfural (5-HMF), erythropoiesis-stimulating substances like erythropoietin, and methylene blue against MetHb formation.
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Affiliation(s)
- Dieter Böning
- Institute of Physiology, Charité Medical University of Berlin, Berlin, Germany
| | - Wolfgang M Kuebler
- Institute of Physiology, Charité Medical University of Berlin, Berlin, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
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22
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Laredo M, Curis E, Masson-Fron E, Voicu S, Mégarbane B. Does COVID-19 alter the oxyhemoglobin dissociation curve? - An observational cohort study using a mixed-effect modelling. Clin Chem Lab Med 2021; 59:e416-e419. [PMID: 34144638 DOI: 10.1515/cclm-2021-0387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Mikael Laredo
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Fédération de Toxicologie, APHP, INSERM UMRS-1144, Université de Paris, Paris, France.,Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Emmanuel Curis
- EA 7537 BioSTM, faculté de pharmacie de Paris & SBIM, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France
| | - Elisabeth Masson-Fron
- Département de Biochimie, Hôpital Lariboisière, APHP, Université de Paris, Paris, France
| | - Sebastian Voicu
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Fédération de Toxicologie, APHP, INSERM UMRS-1144, Université de Paris, Paris, France
| | - Bruno Mégarbane
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Fédération de Toxicologie, APHP, INSERM UMRS-1144, Université de Paris, Paris, France
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23
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Hopp MT, Domingo-Fernández D, Gadiya Y, Detzel MS, Graf R, Schmalohr BF, Kodamullil AT, Imhof D, Hofmann-Apitius M. Linking COVID-19 and Heme-Driven Pathophysiologies: A Combined Computational-Experimental Approach. Biomolecules 2021; 11:biom11050644. [PMID: 33925394 PMCID: PMC8147026 DOI: 10.3390/biom11050644] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023] Open
Abstract
The SARS-CoV-2 outbreak was declared a worldwide pandemic in 2020. Infection triggers the respiratory tract disease COVID-19, which is accompanied by serious changes in clinical biomarkers such as hemoglobin and interleukins. The same parameters are altered during hemolysis, which is characterized by an increase in labile heme. We present two computational–experimental approaches aimed at analyzing a potential link between heme-related and COVID-19 pathophysiologies. Herein, we performed a detailed analysis of the common pathways induced by heme and SARS-CoV-2 by superimposition of knowledge graphs covering heme biology and COVID-19 pathophysiology. Focus was laid on inflammatory pathways and distinct biomarkers as the linking elements. In a second approach, four COVID-19-related proteins, the host cell proteins ACE2 and TMPRSS2 as well as the viral proteins 7a and S protein were computationally analyzed as potential heme-binding proteins with an experimental validation. The results contribute to the understanding of the progression of COVID-19 infections in patients with different clinical backgrounds and may allow for a more individual diagnosis and therapy in the future.
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Affiliation(s)
- Marie-Thérèse Hopp
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, D-53121 Bonn, Germany; (M.-T.H.); (M.S.D.); (R.G.); (B.F.S.)
| | - Daniel Domingo-Fernández
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, D-53757 Sankt Augustin, Germany; (D.D.-F.); (Y.G.); (A.T.K.)
- Enveda Biosciences, Inc., San Francisco, CA 94080, USA
| | - Yojana Gadiya
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, D-53757 Sankt Augustin, Germany; (D.D.-F.); (Y.G.); (A.T.K.)
| | - Milena S. Detzel
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, D-53121 Bonn, Germany; (M.-T.H.); (M.S.D.); (R.G.); (B.F.S.)
| | - Regina Graf
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, D-53121 Bonn, Germany; (M.-T.H.); (M.S.D.); (R.G.); (B.F.S.)
| | - Benjamin F. Schmalohr
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, D-53121 Bonn, Germany; (M.-T.H.); (M.S.D.); (R.G.); (B.F.S.)
| | - Alpha T. Kodamullil
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, D-53757 Sankt Augustin, Germany; (D.D.-F.); (Y.G.); (A.T.K.)
- Causality Biomodels, Kinfra Hi-Tech Park, Kalamassery, Cochin, Kerala 683503, India
| | - Diana Imhof
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, D-53121 Bonn, Germany; (M.-T.H.); (M.S.D.); (R.G.); (B.F.S.)
- Correspondence: (D.I.); (M.H.-A.)
| | - Martin Hofmann-Apitius
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, D-53757 Sankt Augustin, Germany; (D.D.-F.); (Y.G.); (A.T.K.)
- Correspondence: (D.I.); (M.H.-A.)
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24
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Gille T, Sesé L, Aubourg E, Fabre EE, Cymbalista F, Ratnam KC, Valeyre D, Nunes H, Richalet JP, Planès C. The Affinity of Hemoglobin for Oxygen Is Not Altered During COVID-19. Front Physiol 2021; 12:578708. [PMID: 33912067 PMCID: PMC8072381 DOI: 10.3389/fphys.2021.578708] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background: A computational proteomic analysis suggested that SARS-CoV-2 might bind to hemoglobin (Hb). The authors hypothesized that this phenomenon could result in a decreased oxygen (O2) binding and lead to hemolytic anemia as well. The aim of this work was to investigate whether the affinity of Hb for O2 was altered during COVID-19. Methods: In this retrospective, observational, single-center study, the blood gas analyses of 100 COVID-19 patients were compared to those of 100 non-COVID-19 patients. Fifty-five patients with carboxyhemoglobin (HbCO) ≥8% and 30 with sickle cell disease (SCD) were also included ("positive controls" with abnormal Hb affinity). P50 was corrected for body temperature, pH, and PCO2. Results: Patients did not differ statistically for age or sex ratio in COVID-19 and non-COVID-19 groups. Median P50 at baseline was 26 mmHg [25.2-26.8] vs. 25.9 mmHg [24-27.3], respectively (p = 0.42). As expected, P50 was 22.5 mmHg [21.6-23.8] in the high HbCO group and 29.3 mmHg [27-31.5] in the SCD group (p < 0.0001). Whatever the disease severity, samples from COVID-19 to non-COVID-19 groups were distributed on the standard O2-Hb dissociation curve. When considering the time-course of P50 between days 1 and 18 in both groups, no significant difference was observed. Median Hb concentration at baseline was 14 g.dl-1 [12.6-15.2] in the COVID-19 group vs. 13.2 g.dl-1 [11.4-14.7] in the non-COVID-19 group (p = 0.006). Among the 24 COVID-19 patients displaying anemia, none of them exhibited obvious biological hemolysis. Conclusion: There was no biological argument to support the hypothesis that SARS-CoV-2 could alter O2 binding to Hb.
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Affiliation(s)
- Thomas Gille
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Lucile Sesé
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Eric Aubourg
- CNRS, CEA, Astroparticule et Cosmologie, Université de Paris, Paris, France
| | - Emmanuelle E Fabre
- Laboratoire de Biochimie, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 978 ASIH, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Florence Cymbalista
- Inserm UMR 978 ASIH, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France.,Laboratoire d'Hématologie-Biologie, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Kayaththiry Caroline Ratnam
- Laboratoire d'Hématologie-Biologie, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Dominique Valeyre
- Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France.,Service de Pneumologie, Centre de Référence Maladies Pulmonaires Rares, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Hilario Nunes
- Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France.,Service de Pneumologie, Centre de Référence Maladies Pulmonaires Rares, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Jean-Paul Richalet
- Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Carole Planès
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
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25
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Pascual-Guàrdia S, Ferrer A, Díaz Ó, Caguana AO, Tejedor E, Bellido-Calduch S, Rodríguez-Chiaradia DA, Gea J. Absence of Relevant Clinical Effects of SARS-COV-2 on the Affinity of Hemoglobin for O 2 in Patients with COVID-19. Arch Bronconeumol 2021; 57:S0300-2896(21)00113-7. [PMID: 33875283 PMCID: PMC7997137 DOI: 10.1016/j.arbres.2021.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/20/2022]
Abstract
Pulmonary involvement in COVID-19 is frequently associated with alterations in oxygenation. The arterial partial pressure of oxygen (PaO2) is the most clinically used variable to assess such oxygenation, since it decisively influences the oxygen transported by hemoglobin (expressed by its percentage of saturation, SaO2). However, two recent studies conducted respectively in silico and using omic techniques in red blood cells of COVID-19 patients have suggested that SARS-CoV-2 could decrease the affinity of oxygen for the hemoglobin (which would imply that PaO2 would overestimate SaO2), and also reduce the amount of this carrier molecule. OBJECTIVE To evaluate this hypothesis in blood samples from COVID-19 patients. METHODS Blood gases of all COVID-19 patients performed in our laboratory in two months were included, as well as those from two control groups: synchronous patients with negative PCR for SARS-CoV-2 (SCG) and a historical group (HCG). Both SaO2 and venous saturations (SvO2) measured by cooximetry (COX) were compared separately with those calculated using the Kelman (K), Severinghaus (SV) and Siggaard-Andersen (SA) equations in each group. RESULTS Measured and calculated SaO2 and SvO2 were practically equivalent in all groups. Intraclass correlation coefficients (ICC) for SaO2 in COVID-19 were 0.993 for COX-K and 0.992 for both COX-SV and COX-SA; being 0.995 for SvO2 for either COX-K, COX-SV or COX-SA. Hemoglobin and ferritin were slightly higher in COVID-19 compared to SCG and HCG (hemoglobin, p < 0.001 for both; ferritin, p < 0.05 for SCG and p < 0.001 for HCG). CONCLUSION Under clinical conditions SARS-CoV-2 does not have an appreciable influence on the affinity of oxygen for the hemoglobin, nor on the levels of this carrier molecule. Therefore, PaO2 is a good marker of blood oxygenation also in COVID-19.
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Affiliation(s)
- Sergi Pascual-Guàrdia
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Antoni Ferrer
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Óscar Díaz
- Laboratorio de Referencia de Cataluña, El Prat de Llobregat, España
| | - Antonio O Caguana
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Elvira Tejedor
- Laboratorio de Referencia de Cataluña, El Prat de Llobregat, España
| | - Salomé Bellido-Calduch
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Diego A Rodríguez-Chiaradia
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Joaquim Gea
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España.
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26
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Rubano JA, Maloney LM, Simon J, Rutigliano DN, Botwinick I, Jawa RS, Shapiro MJ, Vosswinkel JA, Talamini M, Kaushansky K. An Evolving Clinical Need: Discordant Oxygenation Measurements of Intubated COVID-19 Patients. Ann Biomed Eng 2021; 49:959-963. [PMID: 33469819 PMCID: PMC7815279 DOI: 10.1007/s10439-020-02722-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/30/2020] [Indexed: 12/02/2022]
Abstract
Since the first appearance of the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) earlier this year, clinicians and researchers alike have been faced with dynamic, daily challenges of recognizing, understanding, and treating the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2. Those who are moderately to severely ill with COVID-19 are likely to develop acute hypoxemic respiratory failure and require administration of supplemental oxygen. Assessing the need to initiate or titrate oxygen therapy is largely dependent on evaluating the patient’s existing blood oxygenation status, either by direct arterial blood sampling or by transcutaneous arterial oxygen saturation monitoring, also referred to as pulse oximetry. While the sampling of arterial blood for measurement of dissolved gases provides a direct measurement, it is technically challenging to obtain, is painful to the patient, and can be time and resource intensive. Pulse oximetry allows for non-invasive, real-time, continuous monitoring of the percent of hemoglobin molecules that are saturated with oxygen, and usually closely predicts the arterial oxygen content. As such, it was particularly concerning when patients with severe COVID-19 requiring endotracheal intubation and mechanical ventilation within one of our intensive care units were observed to have significant discordance between their predicted arterial oxygen content via pulse oximetry and their actual measured oxygen content. We offer these preliminary observations along with our speculative causes as a timely, urgent clinical need. In the setting of a COVID-19 intensive care unit, entering a patient room to obtain a fresh arterial blood gas sample not only takes exponentially longer to do given the time required for donning and doffing of personal protective equipment (PPE), it involves the consumption of already sparce PPE, and it increases the risk of viral exposure to the nurse, physician, or respiratory therapist entering the room to obtain the sample. As such, technology similar to pulse oximetry which can be applied to a patients finger, and then continuously monitored from outside the room is essential in preventing a particularly dangerous situation of unrealized hypoxia in this critically-ill patient population. Additionally, it would appear that conventional two-wavelength pulse oximetry may not accurately predict the arterial oxygen content of blood in these patients. This discordance of oxygenation measurements poses a critical concern in the evaluation and management of the acute hypoxemic respiratory failure seen in patients with COVID-19.
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Affiliation(s)
- Jerry A Rubano
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA.
| | - Lauren M Maloney
- Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, NY, USA.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Jessica Simon
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Daniel N Rutigliano
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA
| | - Isadora Botwinick
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA
| | - Randeep S Jawa
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA
| | - Marc J Shapiro
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA
| | - James A Vosswinkel
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA
| | - Mark Talamini
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Kenneth Kaushansky
- Office of the Dean, Renaissance School of Medicine, Stony Brook Medicine, Stony Brook, NY, USA
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27
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DeMartino AW, Rose JJ, Amdahl MB, Dent MR, Shah FA, Bain W, McVerry BJ, Kitsios GD, Tejero J, Gladwin MT. No evidence of hemoglobin damage by SARS-CoV-2 infection. Haematologica 2020; 105:2769-2773. [PMID: 33054129 PMCID: PMC7716349 DOI: 10.3324/haematol.2020.264267] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 disease (COVID-19) has affected over 22 million patients worldwide as of August 2020. As the medical community seeks better understanding of the underlying pathophysiology of COVID-19, several theories have been proposed. One widely shared theory suggests that SARS-CoV-2 proteins directly interact with human hemoglobin (Hb) and facilitate removal of iron from the heme prosthetic group, leading to the loss of functional hemoglobin and accumulation of iron. Herein, we refute this theory. We compared clinical data from 21 critically ill COVID-19 patients to 21 non-COVID-19 ARDS patient controls, generating hemoglobin-oxygen dissociation curves from venous blood gases. This curve generated from the COVID-19 cohort matched the idealized oxygen-hemoglobin dissociation curve well (Pearson correlation, R2 = 0.97, P.
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Affiliation(s)
- Anthony W DeMartino
- Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pittsburgh, PA
| | - Jason J Rose
- Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pittsburgh, PA, USA; Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260.
| | - Matthew B Amdahl
- Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pittsburgh, PA
| | - Matthew R Dent
- Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pittsburgh, PA
| | - Faraaz A Shah
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261, United States; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240
| | - William Bain
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261
| | - Bryan J McVerry
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261
| | - Georgios D Kitsios
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261
| | - Jesús Tejero
- Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pittsburgh, PA, USA; Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, United States; Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
| | - Mark T Gladwin
- Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pittsburgh, PA, USA; Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260
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28
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Le Borgne P, Oberlin M, Bassand A, Abensur Vuillaume L, Gottwalles Y, Noizet M, Gennai S, Baicry F, Jaeger D, Girerd N, Lefebvre F, Bilbault P, Chouihed T. Pre-Hospital Management of Critically Ill Patients with SARS-CoV-2 Infection: A Retrospective Multicenter Study. J Clin Med 2020; 9:E3744. [PMID: 33233324 PMCID: PMC7700636 DOI: 10.3390/jcm9113744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The COVID-19 outbreak had a major impact on healthcare systems worldwide. Our study aims to describe the characteristics and therapeutic emergency mobile service (EMS) management of patients with vital distress due to COVID-19, their in-hospital care pathway and their in-hospital outcome. METHODS This retrospective and multicentric study was conducted in the six main centers of the French Greater East region, an area heavily impacted by the pandemic. All patients requiring EMS dispatch and who were admitted straight to the intensive care unit (ICU) were included. Clinical data from their pre-hospital and hospital management were retrieved. RESULTS We included a total of 103 patients (78.6% male, median age 68). In the initial stage, patients were in a critical condition (median oxygen saturation was 72% (60-80%)). In the field, 77.7% (CI 95%: 71.8-88.3%) were intubated. Almost half of our population (45.6%, CI 95%: 37.1-56.9%) had clinical Phenotype 1 (silent hypoxemia), while the remaining half presented Phenotype 2 (acute respiratory failure). In the ICU, a great number had ARDS (77.7%, CI 95% 71.8-88.3% with a PaO2/FiO2 < 200). In-hospital mortality was 33% (CI 95%: 24.6-43.3%). The two phenotypes showed clinical and radiological differences (respiratory rate, OR = 0.98, p = 0.02; CT scan lesion extension >50%, OR = 0.76, p < 0.03). However, no difference was found in terms of overall in-hospital mortality (OR = 1.07, p = 0.74). CONCLUSION The clinical phenotypes appear to be very distinguishable in the pre-hospital field, yet no difference was found in terms of mortality. This leads us to recommend an identical management in the initial phase, despite the two distinct presentations.
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Affiliation(s)
- Pierrick Le Borgne
- Emergency Department, University Hospital of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; (M.O.); (F.B.); (P.B.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Mathieu Oberlin
- Emergency Department, University Hospital of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; (M.O.); (F.B.); (P.B.)
| | - Adrien Bassand
- Emergency Department, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; (A.B.); (D.J.); (T.C.)
| | - Laure Abensur Vuillaume
- Emergency Department, Regional Hospital of Metz-Thionville, 1, Allée du Château, 57530 Ars-Laquenexy, France;
| | - Yannick Gottwalles
- Emergency Department, General Hospital of Colmar, 39 Avenue de la Liberté, 68024 Colmar, France;
| | - Marc Noizet
- Emergency Department, Mulhouse hospital, 20 Avenue du Dr René Laennec, 68100 Mulhouse, France;
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, 45 Rue Cognac-Jay, 51100 Reims, France;
| | - Florent Baicry
- Emergency Department, University Hospital of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; (M.O.); (F.B.); (P.B.)
| | - Deborah Jaeger
- Emergency Department, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; (A.B.); (D.J.); (T.C.)
| | - Nicolas Girerd
- Centre d’Investigations Cliniques-1433, and INSERM U1116, F-CRIN INI-CRCT, Université de Lorraine, 54000 Nancy, France;
| | - François Lefebvre
- Department of Public Health, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67000 Strasbourg, France;
| | - Pascal Bilbault
- Emergency Department, University Hospital of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; (M.O.); (F.B.); (P.B.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; (A.B.); (D.J.); (T.C.)
- Centre d’Investigations Cliniques-1433, and INSERM U1116, F-CRIN INI-CRCT, Université de Lorraine, 54000 Nancy, France;
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29
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Thomas T, Stefanoni D, Dzieciatkowska M, Issaian A, Nemkov T, Hill RC, Francis RO, Hudson KE, Buehler PW, Zimring JC, Hod EA, Hansen KC, Spitalnik SL, D’Alessandro A. Evidence of Structural Protein Damage and Membrane Lipid Remodeling in Red Blood Cells from COVID-19 Patients. J Proteome Res 2020; 19:4455-4469. [PMID: 33103907 PMCID: PMC7640979 DOI: 10.1021/acs.jproteome.0c00606] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Indexed: 12/13/2022]
Abstract
The SARS-CoV-2 beta coronavirus is the etiological driver of COVID-19 disease, which is primarily characterized by shortness of breath, persistent dry cough, and fever. Because they transport oxygen, red blood cells (RBCs) may play a role in the severity of hypoxemia in COVID-19 patients. The present study combines state-of-the-art metabolomics, proteomics, and lipidomics approaches to investigate the impact of COVID-19 on RBCs from 23 healthy subjects and 29 molecularly diagnosed COVID-19 patients. RBCs from COVID-19 patients had increased levels of glycolytic intermediates, accompanied by oxidation and fragmentation of ankyrin, spectrin beta, and the N-terminal cytosolic domain of band 3 (AE1). Significantly altered lipid metabolism was also observed, in particular, short- and medium-chain saturated fatty acids, acyl-carnitines, and sphingolipids. Nonetheless, there were no alterations of clinical hematological parameters, such as RBC count, hematocrit, or mean corpuscular hemoglobin concentration, with only minor increases in mean corpuscular volume. Taken together, these results suggest a significant impact of SARS-CoV-2 infection on RBC structural membrane homeostasis at the protein and lipid levels. Increases in RBC glycolytic metabolites are consistent with a theoretically improved capacity of hemoglobin to off-load oxygen as a function of allosteric modulation by high-energy phosphate compounds, perhaps to counteract COVID-19-induced hypoxia. Conversely, because the N-terminus of AE1 stabilizes deoxyhemoglobin and finely tunes oxygen off-loading and metabolic rewiring toward the hexose monophosphate shunt, RBCs from COVID-19 patients may be less capable of responding to environmental variations in hemoglobin oxygen saturation/oxidant stress when traveling from the lungs to peripheral capillaries and vice versa.
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Affiliation(s)
- Tiffany Thomas
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Davide Stefanoni
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO, USA
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO, USA
| | - Aaron Issaian
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO, USA
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan C. Hill
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO, USA
| | - Richard O Francis
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Krystalyn E. Hudson
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Paul W. Buehler
- Department of Pathology, University of Maryland, Baltimore, MD, USA
| | - James C. Zimring
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Eldad A. Hod
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Kirk C. Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO, USA
| | - Steven L. Spitalnik
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO, USA
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30
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Vogel DJ, Formenti F, Retter AJ, Vasques F, Camporota L. A left shift in the oxyhaemoglobin dissociation curve in patients with severe coronavirus disease 2019 (COVID-19). Br J Haematol 2020; 191:390-393. [PMID: 33037620 PMCID: PMC7675360 DOI: 10.1111/bjh.17128] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/04/2020] [Indexed: 01/08/2023]
Abstract
Critically ill patients with coronavirus disease 2019 (COVID-19) present with hypoxaemia and are mechanically ventilated to support gas exchange. We performed a retrospective, observational study of blood gas analyses (n = 3518) obtained from patients with COVID-19 to investigate changes in haemoglobin oxygen (Hb-O2 ) affinity. Calculated oxygen tension at half-saturation (p50 ) was on average (±SD) 3·3 (3·13) mmHg lower than the normal p50 value (23·4 vs. 26·7 mmHg; P < 0·0001). Compared to an unmatched historic control of patients with other causes of severe respiratory failure, patients with COVID-19 had a significantly higher Hb-O2 affinity (mean [SD] p50 23·4 [3·13] vs. 24·6 [5.4] mmHg; P < 0·0001). We hypothesise that, due to the long disease process, acclimatisation to hypoxaemia could play a role.
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Affiliation(s)
- Dominik J Vogel
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Federico Formenti
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andrew J Retter
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Francesco Vasques
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luigi Camporota
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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31
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Harutyunyan G, Harutyunyan G, Mkhoyan G, Harutyunyan V, Soghomonyan S. Haemoglobin oxygen affinity in patients with severe COVID-19 infection: Still unclear. Br J Haematol 2020; 190:725-726. [PMID: 32866279 DOI: 10.1111/bjh.17051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/28/2020] [Indexed: 01/28/2023]
Affiliation(s)
| | | | - Gagik Mkhoyan
- Erebouni Medical Center Titogradyan Str, Yerevan, Armenia
| | - Varsenik Harutyunyan
- Universitat de València Facultat de Farmacia Camino del Cementerio, Valencia, Spain
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32
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Shattock MJ, Daniel Y, Hunt BJ, Retter A, Henderson K, Wilson S, Sharpe CC. COVID-19 and haemoglobin oxygen affinity: some clarity? Br J Haematol 2020; 190:723-724. [PMID: 32805061 PMCID: PMC7460983 DOI: 10.1111/bjh.17053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Michael J Shattock
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Yvonne Daniel
- Public Health England, NHS Sickle Cell and Thalassaemia Screening Programme, London, UK
| | | | - Andrew Retter
- Department of Haematology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Katherine Henderson
- Emergency Medicine, Guy's and Saint Thomas' NHS Foundation Trust Infection Service, London, UK
| | - Sarah Wilson
- Viapath Blood Sciences Laboratories, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
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33
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Park KC, Donovan K, McKechnie S, Ramamurthy N, Klenerman P, Swietach P. Single-cell oxygen saturation imaging shows that gas exchange by red blood cells is not impaired in COVID-19 patients. Br J Haematol 2020; 190:e229-e232. [PMID: 32678950 PMCID: PMC7405117 DOI: 10.1111/bjh.17025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kyung Chan Park
- Department of Physiology, Anatomy & GeneticsUniversity of OxfordOxfordUK
| | - Killian Donovan
- Adult Intensive Care UnitJohn Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Stuart McKechnie
- Adult Intensive Care UnitJohn Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Narayan Ramamurthy
- Peter Medawar Building for Pathogen ResearchUniversity of OxfordOxfordUK
| | - Paul Klenerman
- Peter Medawar Building for Pathogen ResearchUniversity of OxfordOxfordUK
| | - Pawel Swietach
- Department of Physiology, Anatomy & GeneticsUniversity of OxfordOxfordUK
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