Lactate Arterial-Central Venous Gradient among COVID-19 Patients in ICU: A Potential Tool in the Clinical Practice

  1. Giuseppe Nardi
  2. Gianfranco Sanson
  3. Lucia Tassinari
  4. Giovanna Guiotto
  5. Antonella Potalivo
  6. Jonathan Montomoli
  7. Fernando Schiraldi

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Objective . In physiological conditions, arterial blood lactate concentration is equal to or lower than central venous blood lactate concentration. A reversal in this rate (i.e., higher lactate concentration in central venous blood), which could reflect a derangement in the mitochondrial metabolism of lung cells induced by inflammation, has been previously reported in patients with ARDS but has been never explored in COVID-19 patients. The aim of this study was to explore if the COVID-19-induced lung cell damage was mirrored by an arterial lactatemia higher than the central venous one; then if the administration of anti-inflammatory therapy (i.e., canakinumab 300 mg subcutaneous) could normalize such abnormal lactate a-cv difference. Methods . A prospective cohort study was conducted, started on March 25, 2020, for a duration of 10 days, enrolling 21 patients affected by severe COVID-19 pneumonia undergoing mechanical ventilation consecutively admitted to the ICU of the Rimini Hospital, Italy. Arterial and central venous blood samples were contemporarily collected to calculate the difference between arterial and central venous lactate (Delta a-cv lactate) concentrations within 24 h from tracheal intubation ( T 0 ) and 24 hours after canakinumab administration ( T 1 ). Results . At T 0 , 19 of 21 (90.5%) patients showed a pathologic Delta a-cv lactate (median 0.15 mmol/L; IQR 0.07–0.25). In the 13 patients undergoing canakinumab administration, at T 1 , Delta a-cv lactate decreased in 92.3% of cases, the decrease being statistically significant ( T 0 : median 0.24, IQR 0.09–0.31 mmol/L; T 1 : median −0.01, IQR −0.08–0.04 mmol/L; p = 0.002 ). Conclusion . A reversed Delta a-cv lactate might be interpreted as one of the effects of COVID-19-related cytokine storm, which could reflect a derangement in the mitochondrial metabolism of lung cells induced by severe inflammation or other uncoupling mediators. In addition, Delta a-cv lactate decrease might also reflect the anti-inflammatory activity of canakinumab. Our preliminary findings need to be confirmed by larger outcome studies.

Article activity feed

  1. Version published to 10.1155/2020/4743904
  2. ScreenIT

    SciScore for 10.1101/2020.05.08.20095042: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Hospital Ethical Board.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using the software IBM SPSS Statistics, version 24.0 (Armonk, NY, US: IBM Corp.).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Our preliminary report has several methodologic limitations, that should be considered when interpreting our results. The study had an observational design with descriptive and correlational aims and enrolled a rather small sample in a single center. Therefore, the possible causative relationship between canakinumab administration and Delta a-cv lactate decrease, as well as the predictive power of this variables on patients’ key outcomes, should be tested in larger populations and after considering relevant confounders. Moreover, although our findings may be explained by the effect of the administered drug, a direct comparison of the trend of the Delta a-cv lactate in a group of patients receiving the standard of care was hampered by the lack of a control group.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04348448Not yet recruitingObservational Study, Use of Canakinumab Administered Subcuta…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.05.08.20095042v1 on medRxiv