Journal of Personalized Medicine (Dec 2023)

Evaluation of the Acid–Base Status in Patients Admitted to the ICU Due to Severe COVID-19: Physicochemical versus Traditional Approaches

  • Zoi Sotiropoulou,
  • Elvira Markela Antonogiannaki,
  • Evangelia Koukaki,
  • Stavroula Zaneli,
  • Agamemnon Bakakos,
  • Angelos Vontetsianos,
  • Nektarios Anagnostopoulos,
  • Nikoleta Rovina,
  • Konstantinos Loverdos,
  • Paraskevi Tripolitsioti,
  • Magdalini Kyriakopoulou,
  • Konstantinos Pontikis,
  • Petros Bakakos,
  • Dimitrios Georgopoulos,
  • Andriana I. Papaioannou

DOI
https://doi.org/10.3390/jpm13121700
Journal volume & issue
Vol. 13, no. 12
p. 1700

Abstract

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Background: Stewart’s approach is known to have better diagnostic accuracy for the identification of metabolic acid–base disturbances compared to traditional methods based either on plasma bicarbonate concentration ([HCO3−]) and anion gap (AG) or on base excess/deficit (BE). This study aimed to identify metabolic acid–base disorders using either Stewart’s or traditional approaches in critically ill COVID-19 patients admitted to the ICU, to recognize potential hidden acid–base metabolic abnormalities and to assess the prognostic value of these abnormalities for patient outcome. Methods: This was a single-center retrospective study, in which we collected data from patients with severe COVID-19 admitted to the ICU. Electronical files were used to retrieve data for arterial blood gases, serum electrolytes, and proteins and to derive [HCO3−], BE, anion gap (AG), AG adjusted for albumin (AGadj), strong ion difference, strong ion gap (SIG), and SIG corrected for water excess/deficit (SIGcorr). The acid–base status was evaluated in each patient using the BE, [HCO3−], and physicochemical approaches. Results: We included 185 patients. The physicochemical approach detected more individuals with metabolic acid–base abnormalities than the BE and [HCO3−] approaches (p 3 62/186 (33%) methods. Regarding the derived acid–base status variables, non-survivors had greater AGadj, (p = 0.013) and SIGcorr (p = 0.035) compared to survivors. Conclusions: The identification of hidden acid–base disturbances may provide a detailed understanding of the underlying conditions in patients and of the possible pathophysiological mechanisms implicated. The association of these acid–base abnormalities with mortality provides the opportunity to recognize patients at increased risk of death and support them accordingly.

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