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Panminerva Medica 2022 Feb 04

DOI: 10.23736/S0031-0808.22.04562-1

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Gas-exchange deficit and systemic hypoperfusion in COVID-19 and non-COVID-19 young adult patients with pneumonia

Stefano FRANCHINI 1 , Francesca METTE 1, Giovanni LANDONI 2, 3, Eleonora SETTI 1, Luca FERRANTE 1, Barbara CALCATERRA 1, Gaia PAGLIULA 1, Alessandra BARBIERI 3, Dario FONTANI 3, Giorgia BORIO 3, Marta CITRO 3, Federica FAROLFI 3, Gloria SUMA 3, Giacomo MONTI 2, Sergio COLOMBO 2, Lorenzo DAGNA 3, 4, Patrizia ROVERE-QUERINI 3, 5, Francesco DE COBELLI 3, 6, Antonella CASTAGNA 3, 7, Fabio CICERI 3, 8, Alberto ZANGRILLO 2, 3, Moreno TRESOLDI 9, Antonio SECCHI 3, 10, Massimiliano ETTERI 1

1 Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; 2 Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; 3 School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; 4 Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy; 5 Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; 6 Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; 7 Department of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy; 8 Hematology and Bone Marrow Transplant Unit, IRCCS Ospedale San Raffaele, Milan, Italy; 9 General Medicine and Advanced Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy; 10 Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy



BACKGROUND: Lung damage leading to gas-exchange deficit and sepsis leading to systemic hypoperfusion are well-known features of severe pneumonia. Although frequently described in COVID-19, their prognostic impact in COVID-19-related pneumonia vs COVID-19-urelated pneumonia has never been compared. This study assesses fundamental gas-exchange and hemodynamic parameters and explores their prognostic impact in COVID-19 pneumonia and non-COVID-19 pneumonia.
METHODS: We prospectively evaluated arterial pO2/FiO2, alveolar to arterial O2 gradient, shock index, and serum lactate in 126 COVID-19 pneumonia patients, aged 18- 65, presenting to the emergency department with acute, non-hypercapnic respiratory failure. As a control group we identified 1:1 age-, sex-, and pO2/FiO2-matched COVID-19-urelated pneumonia patients. Univariate and multivariable predictors of 30-day survival were identified in both groups.
RESULTS: COVID-19 patients showed lower arterial serum lactate concentration (p<0.001) and shock index (p<0.001) values as compared to non-COVID-19 patients. While we did not observe differences in lactate concentration or in shock index values in deceased vs surviving COVID-19 patients (respectively, p=0.7 and p=0.6), non-COVID-19 deceased patients showed significantly higher lactate and shock index than non-COVID-19 survivors (p<0.001 and p=0.03). The pO2/FiO2 was the most powerful determinant of survival by Cox regression multivariate analysis in COVID-19 patients (p=0.006), while it was lactate in non-COVID-19 patients (p=0.001).
CONCLUSIONS: As compared to COVID19-unrelated pneumonia, COVID-19 pneumonia outcome seems more strictly correlated to the extent of lung damage, rather than to the systemic circulatory and metabolic derangements typical of sepsis.


KEY WORDS: Covid-19; Pneumonia; Sepsis; Hypoperfusion; Gas-exchange deficit

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