Nardi Giuseppe, Sanson Gianfranco, Tassinari Lucia, Guiotto Giovanna, Potalivo Antonella, Montomoli Jonathan, Schiraldi Fernando
Dept. of Anaesthesia and Intensive Care, Infermi Hospital, Viale Settembrini 2, 47921 Rimini, Italy.
Clinical Dept. of Medical, Surgical and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149 Trieste, Italy.
Crit Care Res Pract. 2020 Sep 25;2020:4743904. doi: 10.1155/2020/4743904. eCollection 2020.
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.
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 ( ) and 24 hours after canakinumab administration ( ).
At , 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 , Delta a-cv lactate decreased in 92.3% of cases, the decrease being statistically significant ( : median 0.24, IQR 0.09-0.31 mmol/L; : median -0.01, IQR -0.08-0.04 mmol/L; =0.002).
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.
在生理条件下，动脉血乳酸浓度等于或低于中心静脉血乳酸浓度。先前已有报道，在急性呼吸窘迫综合征（ARDS）患者中，这种比率出现了逆转（即中心静脉血中乳酸浓度更高），这可能反映了炎症诱导的肺细胞线粒体代谢紊乱，但在新型冠状病毒肺炎（COVID-19）患者中从未进行过探究。本研究的目的是探讨COVID-19诱导的肺细胞损伤是否表现为动脉血乳酸血症高于中心静脉血乳酸血症；以及抗炎治疗（即皮下注射300毫克卡那单抗）是否能使这种异常的动脉-中心静脉乳酸差异恢复正常。
进行了一项前瞻性队列研究，于2020年3月25日开始，为期10天，纳入21例连续入住意大利里米尼医院重症监护病房（ICU）、接受机械通气的重症COVID-19肺炎患者。在气管插管后24小时内（ ）和注射卡那单抗24小时后（ ），同时采集动脉血和中心静脉血样本，以计算动脉血和中心静脉血乳酸浓度的差值（动脉-中心静脉乳酸差值）。
在 时，21例患者中有19例（90.5%）的动脉-中心静脉乳酸差值呈病理性（中位数0.15毫摩尔/升；四分位间距0.07 - 0.25）。在接受卡那单抗治疗的13例患者中，在 时，92.3%的病例动脉-中心静脉乳酸差值下降，下降具有统计学意义（ ：中位数0.24，四分位间距0.09 - 0.31毫摩尔/升； ：中位数 -0.01，四分位间距 -0.08 - 0.04毫摩尔/升； =0.002）。
动脉-中心静脉乳酸差值逆转可能被解释为COVID-19相关细胞因子风暴的影响之一，这可能反映了严重炎症或其他解偶联介质诱导的肺细胞线粒体代谢紊乱。此外，动脉-中心静脉乳酸差值下降也可能反映了卡那单抗的抗炎活性。我们的初步研究结果需要通过更大规模的结局研究来证实。
