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de Souza SP, Caldas JR, Lopes MB, Duarte Silveira MA, Coelho FO, Oliveira Queiroz I, Domingues Cury P, Passos RDH. Physico-chemical characterization of acid base disorders in patients with COVID-19: A cohort study. World J Nephrol 2024; 13:92498. [PMID: 38983762 PMCID: PMC11229835 DOI: 10.5527/wjn.v13.i2.92498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/08/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Acid-base imbalance has been poorly described in patients with coronavirus disease 2019 (COVID-19). Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution that may have been overlooked using traditional acid-base analysis techniques. In a cohort of critically ill COVID-19 patients, we looked for an association between metabolic acidosis surrogates and worse clinical outcomes, such as mortality, renal dialysis, and length of hospital stay. AIM To describe the acid-base disorders of critically ill COVID-19 patients using Stewart's approach, associating its variables with poor outcomes. METHODS This study pertained to a retrospective cohort comprised of adult patients who experienced an intensive care unit stay exceeding 4 days and who were diagnosed with severe acute respiratory syndrome coronavirus 2 infection through a positive polymerase chain reaction analysis of a nasal swab and typical pulmonary involvement observed in chest computed tomography scan. Laboratory and clinical data were obtained from electronic records. Categorical variables were compared using Fisher's exact test. Continuous data were presented as median and interquartile range. The Mann-Whitney U test was used for comparisons. RESULTS In total, 211 patients were analyzed. The mortality rate was 13.7%. Overall, 149 patients (70.6%) presented with alkalosis, 28 patients (13.3%) had acidosis, and the remaining 34 patients (16.2%) had a normal arterial pondus hydrogenii. Of those presenting with acidosis, most had a low apparent strong ion difference (SID) (20 patients, 9.5%). Within the group with alkalosis, 128 patients (61.0%) had respiratory origin. The non-survivors were older, had more comorbidities, and had higher Charlson's and simplified acute physiology score 3. We did not find severe acid-base imbalance in this population. The analyzed Stewart's variables (effective SID, apparent SID, and strong ion gap and the effect of albumin, lactate, phosphorus, and chloride) were not different between the groups. CONCLUSION Alkalemia is prevalent in COVID-19 patients. Although we did not find an association between acid-base variables and mortality, the use of Stewart's methodology may provide insights into this severe disease.
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Affiliation(s)
- Sergio Pinto de Souza
- Department of Nephrology, Hospital São Rafael, Salvador, BA 41253190, Brazil
- Department of Nephrology, D’Or Institute for Research and Education (IDOR), Salvador, BA 41253190, Brazil
- Faculty of Medicine, Escola Bahiana de Medicina e Saúde Pública-EBMSP, Salvador, BA 40290000, Brazil
| | - Juliana R Caldas
- Department of Intensive Care, D’Or Institute for Research and Education (IDOR), Salvador, BA 41253190, Brazil
| | - Marcelo Barreto Lopes
- Department of Nephrology, Hospital São Rafael, Salvador, BA 41253190, Brazil
- Department of Nephrology, D’Or Institute for Research and Education (IDOR), Salvador, BA 41253190, Brazil
| | - Marcelo Augusto Duarte Silveira
- Department of Nephrology, Hospital São Rafael, Salvador, BA 41253190, Brazil
- Department of Nephrology, D’Or Institute for Research and Education (IDOR), Salvador, BA 41253190, Brazil
| | - Fernanda Oliveira Coelho
- Department of Nephrology, Hospital São Rafael, Salvador, BA 41253190, Brazil
- Department of Nephrology, D’Or Institute for Research and Education (IDOR), Salvador, BA 41253190, Brazil
| | - Igor Oliveira Queiroz
- Hospital São Rafael, D’Or Institute for Research and Education (IDOR), Salvador, BA 41253190, Brazil
| | - Pedro Domingues Cury
- Hospital São Rafael, D’Or Institute for Research and Education (IDOR), Salvador, BA 41253190, Brazil
| | - Rogério da Hora Passos
- Department of Intensive Care Unit, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652900, Brazil
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Caldwell HG, Carr JMJR, Minhas JS, Swenson ER, Ainslie PN. Acid-base balance and cerebrovascular regulation. J Physiol 2021; 599:5337-5359. [PMID: 34705265 DOI: 10.1113/jp281517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022] Open
Abstract
The regulation and defence of intracellular pH is essential for homeostasis. Indeed, alterations in cerebrovascular acid-base balance directly affect cerebral blood flow (CBF) which has implications for human health and disease. For example, changes in CBF regulation during acid-base disturbances are evident in conditions such as chronic obstructive pulmonary disease and diabetic ketoacidosis. The classic experimental studies from the past 75+ years are utilized to describe the integrative relationships between CBF, carbon dioxide tension (PCO2 ), bicarbonate (HCO3 - ) and pH. These factors interact to influence (1) the time course of acid-base compensatory changes and the respective cerebrovascular responses (due to rapid exchange kinetics between arterial blood, extracellular fluid and intracellular brain tissue). We propose that alterations in arterial [HCO3 - ] during acute respiratory acidosis/alkalosis contribute to cerebrovascular acid-base regulation; and (2) the regulation of CBF by direct changes in arterial vs. extravascular/interstitial PCO2 and pH - the latter recognized as the proximal compartment which alters vascular smooth muscle cell regulation of CBF. Taken together, these results substantiate two key ideas: first, that the regulation of CBF is affected by the severity of metabolic/respiratory disturbances, including the extent of partial/full acid-base compensation; and second, that the regulation of CBF is independent of arterial pH and that diffusion of CO2 across the blood-brain barrier is integral to altering perivascular extracellular pH. Overall, by realizing the integrative relationships between CBF, PCO2 , HCO3 - and pH, experimental studies may provide insights to improve CBF regulation in clinical practice with treatment of systemic acid-base disorders.
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Affiliation(s)
- Hannah G Caldwell
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Okanagan, Kelowna, Canada
| | - Jay M J R Carr
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Okanagan, Kelowna, Canada
| | - Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Erik R Swenson
- Pulmonary, Critical Care and Sleep Medicine Division, University of Washington, and VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Okanagan, Kelowna, Canada
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João Pedro AM, Marques TM, dos Santos Leal LD, Alves Santos PS, de Souza Ferreira JP, Dominguez R, da Silva SF, Story DA, Rossiter HB, Effros RM, van Schalkwyk JM. Commentaries on Viewpoint: Stewart's approach to quantitative acid-base physiology should replace traditional bicarbonate-centered models. J Appl Physiol (1985) 2021; 130:2022-2023. [PMID: 34142891 DOI: 10.1152/japplphysiol.00327.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Assis Moreira João Pedro
- Grupo de estudo e pesquisa em respostas neuromusculares, Universidade Federal de Lavras, Lavras, Brazil,Programa de Pós-Graduação em Nutrição e Saúde Universidade Federal de Lavras, Lavras, Brazil
| | - Thais Melo Marques
- Grupo de estudo e pesquisa em respostas neuromusculares, Universidade Federal de Lavras, Lavras, Brazil,Programa de Pós-Graduação em Nutrição e Saúde Universidade Federal de Lavras, Lavras, Brazil
| | - Ludmila Dias dos Santos Leal
- Grupo de estudo e pesquisa em respostas neuromusculares, Universidade Federal de Lavras, Lavras, Brazil,Programa de Pós-Graduação em Nutrição e Saúde Universidade Federal de Lavras, Lavras, Brazil
| | - Paula Souza Alves Santos
- Grupo de estudo e pesquisa em respostas neuromusculares, Universidade Federal de Lavras, Lavras, Brazil,Programa de Pós-Graduação em Nutrição e Saúde Universidade Federal de Lavras, Lavras, Brazil
| | - Joao Pedro de Souza Ferreira
- Grupo de estudo e pesquisa em respostas neuromusculares, Universidade Federal de Lavras, Lavras, Brazil,Programa de Pós-Graduação em Nutrição e Saúde Universidade Federal de Lavras, Lavras, Brazil
| | - Raul Dominguez
- Grupo de estudo e pesquisa em respostas neuromusculares, Universidade Federal de Lavras, Lavras, Brazil,Departamento de Motricidad Humana y Rendimiento Deportivo, Universidad de Sevilla, Sevilla, Spain
| | - Sandro Fernandes da Silva
- Grupo de estudo e pesquisa em respostas neuromusculares, Universidade Federal de Lavras, Lavras, Brazil,Programa de Pós-Graduação em Nutrição e Saúde Universidade Federal de Lavras, Lavras, Brazil
| | - David A Story
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Harry B Rossiter
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Richard M Effros
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
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Rubin DM. Last Word on Viewpoint: Stewart's approach to quantitative acid-base physiology should replace traditional bicarbonate-centered models. J Appl Physiol (1985) 2021; 130:2024. [PMID: 34142907 DOI: 10.1152/japplphysiol.00360.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- David M Rubin
- Biomedical Engineering Research Group, University of the Witwatersrand, Johannesburg, South Africa
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