Lorente L, Gómez-Bernal F, Martín MM, Navarro-Gonzálvez JA, Argueso M, Perez A, Ramos-Gómez L, Solé-Violán J, Marcos Y Ramos JA, Ojeda N, Jiménez A. High serum nitrates levels in non-survivor COVID-19 patients.
Med Intensiva 2020;
46:S0210-5691(20)30336-3. [PMID:
33293102 PMCID:
PMC7654288 DOI:
10.1016/j.medin.2020.10.003]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE
Higher blood nitrate and nitrite levels have been found in coronavirus disease 2019 (COVID-19) patients than in healthy subjects. The present study explores the potential association between serum nitrate levels and mortality in COVID-19 patients.
DESIGN
A prospective observation study was carried out.
SETTING
Eight Intensive Care Units (ICUs) from 6 hospitals in the Canary Islands (Spain).
PATIENTS
COVID-19 patients admitted to the ICU.
INTERVENTIONS
Determination of serum nitrate levels at ICU admission.
MAIN VARIABLE OF INTEREST
Mortality at 30 days.
RESULTS
Non-surviving (n=11) compared to surviving patients (n=42) showed higher APACHE-II (p<0.001) and SOFA scores (p=0.004), and higher serum nitrate levels (p=0.001). Logistic regression analyses showed serum nitrate levels to be associated to 30-day mortality after controlling for SOFA (OR=1.021; 95%CI=1.006-1.036; p=0.01) or APACHE-II (OR=1.023; 95%CI=1.006-1.041; p=0.01). There were no differences in the area under the curve (AUC) for mortality prediction by serum nitrate levels (AUC=83%; 95%CI=73-92%; p<0.001), APACHE II (AUC=85%; 95%CI=75-96%; p<0.001) and SOFA (AUC=78%; 95%CI=63-92%; p=0.005) based on the DeLong method. The Kaplan-Meier analysis found patients with serum nitrates levels>68.4μmol/l to have a higher mortality rate (hazard ratio=138.8; 95%CI=22.3-863.9; p<0.001).
CONCLUSIONS
The main novel finding was the association between serum nitrate levels and mortality in COVID-19 patients controlling for the SOFA or APACHE-II scores, though larger studies are needed to confirm this observation.
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