tetano
Editor, Senior Moderator
Med Intensiva
. 2020 Nov 10;S0210-5691(20)30336-3.
doi: 10.1016/j.medin.2020.10.003. Online ahead of print.
High serum nitrates levels in non-survivor COVID-19 patients
[Article in En, Spanish]
L Lorente[SUP] 1 [/SUP], F G?mez-Bernal[SUP] 2 [/SUP], M M Mart?n[SUP] 3 [/SUP], J A Navarro-Gonz?lvez[SUP] 2 [/SUP], M Argueso[SUP] 4 [/SUP], A Perez[SUP] 5 [/SUP], L Ramos-G?mez[SUP] 6 [/SUP], J Sol?-Viol?n[SUP] 7 [/SUP], J A Marcos Y Ramos[SUP] 8 [/SUP], N Ojeda[SUP] 9 [/SUP], A Jim?nez[SUP] 10 [/SUP], Working Group on COVID-19 Canary ICU
Affiliations
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.
Keywords: COVID-19; Mortalidad; Mortality; Niveles s?ricos de nitratos; Patients; Prognosis; Pron?stico; Serum nitrate levels.
. 2020 Nov 10;S0210-5691(20)30336-3.
doi: 10.1016/j.medin.2020.10.003. Online ahead of print.
High serum nitrates levels in non-survivor COVID-19 patients
[Article in En, Spanish]
L Lorente[SUP] 1 [/SUP], F G?mez-Bernal[SUP] 2 [/SUP], M M Mart?n[SUP] 3 [/SUP], J A Navarro-Gonz?lvez[SUP] 2 [/SUP], M Argueso[SUP] 4 [/SUP], A Perez[SUP] 5 [/SUP], L Ramos-G?mez[SUP] 6 [/SUP], J Sol?-Viol?n[SUP] 7 [/SUP], J A Marcos Y Ramos[SUP] 8 [/SUP], N Ojeda[SUP] 9 [/SUP], A Jim?nez[SUP] 10 [/SUP], Working Group on COVID-19 Canary ICU
Affiliations
- PMID: 33293102
- DOI: 10.1016/j.medin.2020.10.003
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.
Keywords: COVID-19; Mortalidad; Mortality; Niveles s?ricos de nitratos; Patients; Prognosis; Pron?stico; Serum nitrate levels.