Research Article
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Can PCO2 be a mortality predictor in COVID-19 patients?

Year 2022, , 268 - 274, 26.09.2022
https://doi.org/10.47582/jompac.1158464

Abstract

Aim: The clinical course of Corona Virus Disease 2019 (COVID-19) infection is ranging from asymptomatic to moderate and severe disease with low survival rates. Therefore, reliable prediction of COVID-19 mortality and identification of contributing factors would allow targeted therapies for high-risk individuals. We aimed to determine whether partial carbon dioxide (PCO2) concentrations could predict mortality in patients treated in the intensive care unit (ICU).
Material and Method: Acute Physiology and Chronic Health Evaluation (APACHE -2) scores, ferritin, lymphocyte count, neutrophil lymphocyte ratio (NLR), PCO2, partial oxygen concentration to inspired oxygen fraction (P/F) ratio were retrospectively determined and were compared between survivors and non-survivors.
Results: The mean APACHE-2 value was higher in Group Non-survivors than in Group Survivors. Patients in Group Non-survivors were significantly older than those in Group Survivors (p=0,012). From day 7, low baseline lymphocyte counts were significant for mortality (p=0,046). NLR was also high at ICU admission, and it was significant for mortality from the 7th day (p=0.022). From day 10, PCO2 and ferritin levels increased in Group Non-survivors. The P/F ratio increased with treatment in both groups during the first 10 days, and after day 13, the increase continued in Group Survivors, whereas the values decreased in Group Non-survivors. We found that PCO2 concentrations in patients at ICU admission were as expected and that the increase in PCO2 could predict mortality along with increased ferritin levels, older age, high APACHE scores, low lymphocyte count, elevated NLR and high P/F ratio.
Conclusion: This study showed that in patients with COVID -19, an increase in PCO2 concentration can predict mortality along with increased ferritin levels, older age, high APACHE scores, low lymphocyte count, elevated NLR and high P/F ratio.

Supporting Institution

None

Project Number

None

Thanks

I am grateful to all my colleagues and allied health personnel working in the intensive care unit for their dedication during the COVID pandemic.

References

  • Organization WH. Worl Healthy Organisation Coronavirus (COVID-19) Dashboard 2022 [Available from: https://covid19.who.int/.
  • Satpathy S, Mangla M, Sharma N, Deshmukh H, Mohanty S. Predicting mortality rate and associated risks in COVID-19 patients. Spatial Information Research 2021; 29: 455-64.
  • Yadaw AS, Li YC, Bose S, Iyengar R, Bunyavanich S, Pandey G. Clinical features of COVID-19 mortality: development and validation of a clinical prediction model. Lancet Digit Health 2020; 2: e516-e25.
  • Ryan L, Lam C, Mataraso S, et al. Mortality prediction model for the triage of COVID-19, pneumonia, and mechanically ventilated ICU patients: A retrospective study. Ann Med Surg (Lond) 2020; 59: 207-16.
  • Hu C, Liu Z, Jiang Y, et al. Early prediction of mortality risk among patients with severe COVID-19, using machine learning. International Journal of Epidemiology 2020; 49: 1918-29.
  • Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-9.
  • Vélez-Paez JL, Montalvo MP, Jara FE, et al. Predicting mortality in critically ill patients with COVID-19 in the ICU from a secondary-level hospital in Ecuador 2022.
  • Henry B, Cheruiyot I, Vikse J, et al. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: a meta-analysis. Acta bio-medica : Atenei Parmensis 2020; 91: e2020008-e.
  • Güneysu F, Guner NG, Erdem AF, Durmus E, Durgun Y, Yurumez Y. Can COVID-19 Mortality be Predicted in the Emergency Room? J Coll Physicians Surg Pak 2020; 30: 928-32.
  • Asghar MS, Khan NA, Haider Kazmi SJ, et al. Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis. J Community Hosp Intern Med Perspect 2020; 10: 514-20.
  • Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest 2020; 130: 2620-9.
  • Gómez-Pastora J, Weigand M, Kim J, et al. Hyperferritinemia in critically ill COVID-19 patients–is ferritin the product of inflammation or a pathogenic mediator? Clin Chim Acta 2020; 509: 249.
  • Ahmed S, Ansar Ahmed Z, Siddiqui I, Haroon Rashid N, Mansoor M, Jafri L. Evaluation of serum ferritin for prediction of severity and mortality in COVID-19- A cross sectional study. Ann Med Surg 2021; 63: 102163.
  • Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307: 2526-33.
  • Gattinoni L, Busana M, Camporota L. Standardised PaO2/FiO2 ratio in COVID-19: Added value or risky assumptions? Eur J Intern Med 2021; 92: 31-3.
  • Hernandez-Romieu AC, Adelman MW, Hockstein MA, et al. Timing of intubation and mortality among critically ill coronavirus disease 2019 patients: a single-center cohort study. Crit Care Med 2020; 48: e1045-e53.
  • Bellan M, Patti G, Hayden E, et al. Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients. Scientific Reports 2020; 10: 20731.

PCO2, COVID-19 hastalarında mortalite belirteci olabilir mi?

Year 2022, , 268 - 274, 26.09.2022
https://doi.org/10.47582/jompac.1158464

Abstract

Amaç: Corona Virüs Hastalığı 2019 (COVID-19) enfeksiyonunun klinik seyri, asemptomatikten düşük sağkalım oranlarına sahip orta ve şiddetli hastalığa kadar değişmektedir. Bu nedenle, COVID-19 mortalitesinin güvenilir bir şekilde tahmin edilmesi ve katkıda bulunan faktörlerin belirlenmesi, yüksek riskli bireyler için hedefe yönelik tedavilere olanak sağlayacaktır. Yoğun bakım ünitesinde (YBÜ) tedavi edilen COVID-19 hastalarında kısmi karbon dioksit (PCO2) konsantrasyonlarının mortaliteyi tahmin edip edemeyeceğini belirlemeyi amaçladık.
Gereç ve Yöntem: Akut fizyoloji ve kronik sağlık değerlendirmesi (APACHE -2) skorları, ferritin, lenfosit sayısı, nötrofil lenfosit oranı (NLR), PCO2, kısmi oksijen konsantrasyonu/inspire edilen oksijen fraksiyon oranı (P/F) hasta dosyaları taranarak belirlendi ve hayatta kalanlarla ölen hastalar karşılaştırıldı.
Bulgular: Ortalama APACHE-2 değeri ölen grupta sağ kalanlardan daha yüksekti. Ölen hastalar, sağ kalanlardan anlamlı olarak daha yaşlıydı (p=0,012). 7. günden itibaren, düşük bazal lenfosit sayıları mortalite için önemliydi (p=0,046). NLR, yoğun bakıma yatışta da yüksekti ve 7. günden itibaren mortalite açısından anlamlıydı (p=0,022). 10. günden itibaren, ölen grubunda PCO2 ve ferritin seviyeleri arttı. İlk 10 gün boyunca her iki grupta da tedavi ile P/F oranı arttı ve 13. günden sonra artış sağ kalanlarda devam ederken, ölen grubunda değerler azaldı.
Sonuç: Bu çalışma, COVID-19 hastalarında PCO2 konsantrasyonundaki artışın, yüksek ferritin seviyesi, ileri yaş, yüksek APACHE skorları, düşük lenfosit sayısı, yüksek NLR ve yüksek P/F oranı ile birlikte mortaliteyi öngörebileceğini göstermiştir.

Project Number

None

References

  • Organization WH. Worl Healthy Organisation Coronavirus (COVID-19) Dashboard 2022 [Available from: https://covid19.who.int/.
  • Satpathy S, Mangla M, Sharma N, Deshmukh H, Mohanty S. Predicting mortality rate and associated risks in COVID-19 patients. Spatial Information Research 2021; 29: 455-64.
  • Yadaw AS, Li YC, Bose S, Iyengar R, Bunyavanich S, Pandey G. Clinical features of COVID-19 mortality: development and validation of a clinical prediction model. Lancet Digit Health 2020; 2: e516-e25.
  • Ryan L, Lam C, Mataraso S, et al. Mortality prediction model for the triage of COVID-19, pneumonia, and mechanically ventilated ICU patients: A retrospective study. Ann Med Surg (Lond) 2020; 59: 207-16.
  • Hu C, Liu Z, Jiang Y, et al. Early prediction of mortality risk among patients with severe COVID-19, using machine learning. International Journal of Epidemiology 2020; 49: 1918-29.
  • Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-9.
  • Vélez-Paez JL, Montalvo MP, Jara FE, et al. Predicting mortality in critically ill patients with COVID-19 in the ICU from a secondary-level hospital in Ecuador 2022.
  • Henry B, Cheruiyot I, Vikse J, et al. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: a meta-analysis. Acta bio-medica : Atenei Parmensis 2020; 91: e2020008-e.
  • Güneysu F, Guner NG, Erdem AF, Durmus E, Durgun Y, Yurumez Y. Can COVID-19 Mortality be Predicted in the Emergency Room? J Coll Physicians Surg Pak 2020; 30: 928-32.
  • Asghar MS, Khan NA, Haider Kazmi SJ, et al. Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis. J Community Hosp Intern Med Perspect 2020; 10: 514-20.
  • Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest 2020; 130: 2620-9.
  • Gómez-Pastora J, Weigand M, Kim J, et al. Hyperferritinemia in critically ill COVID-19 patients–is ferritin the product of inflammation or a pathogenic mediator? Clin Chim Acta 2020; 509: 249.
  • Ahmed S, Ansar Ahmed Z, Siddiqui I, Haroon Rashid N, Mansoor M, Jafri L. Evaluation of serum ferritin for prediction of severity and mortality in COVID-19- A cross sectional study. Ann Med Surg 2021; 63: 102163.
  • Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307: 2526-33.
  • Gattinoni L, Busana M, Camporota L. Standardised PaO2/FiO2 ratio in COVID-19: Added value or risky assumptions? Eur J Intern Med 2021; 92: 31-3.
  • Hernandez-Romieu AC, Adelman MW, Hockstein MA, et al. Timing of intubation and mortality among critically ill coronavirus disease 2019 patients: a single-center cohort study. Crit Care Med 2020; 48: e1045-e53.
  • Bellan M, Patti G, Hayden E, et al. Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients. Scientific Reports 2020; 10: 20731.
There are 17 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Alparslan Koç

Project Number None
Publication Date September 26, 2022
Published in Issue Year 2022

Cite

AMA Koç A. Can PCO2 be a mortality predictor in COVID-19 patients?. J Med Palliat Care / JOMPAC / Jompac. September 2022;3(3):268-274. doi:10.47582/jompac.1158464

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