Humbel Simona, Wendel-Garcia Pedro David, Unseld Simone, Noll Fabienne, Schuepbach Reto Andreas, Ganter Christoph Camille, Seeger Harald, David Sascha, Andermatt Rea
Institute of Intensive Care Medicine, University Hospital Zurich, 8091 Zurich, Switzerland.
Department of Obstetrics, University Hospital Zurich, 8091 Zurich, Switzerland.
J Clin Med. 2022 Jul 22;11(15):4273. doi: 10.3390/jcm11154273.
Renal tubular acidosis (RTA) is an extremely rare cause of metabolic acidosis (10 in 100,000). RTA has been linked neither to pregnancy nor to severe coronavirus disease 2019 (COVID-19). The purpose of this study was to analyze the prevalence and clinical course of normal anion gap metabolic acidosis in critically ill pregnant COVID-19 patients and to compare them to an age-matched nonpregnant female patient cohort.
Secondary analysis was conducted on a prospective observational cohort of critically ill patients suffering from COVID-19 consecutively admitted to a tertiary intensive care unit (ICU) between February 2020 and April 2021.
A total of 321 COVID-19 patients required admission to the ICU; 95 (30%) were female, and 18 (19%) were of childbearing age. Seven of eight (88%) pregnant women (all in the last trimester) required advanced respiratory support due to COVID-19. The estimated glomerular filtration rate was 135 (123-158) mL/min/m body surface area, and six pregnant women (86%) were diagnosed with a normal, respiratory compensated, anion gap metabolic acidosis (pH 7.3 (7.18-7.31), HCO 14.8 (12.8-18.6) mmol/L, and paCO 3.4 (3.3-4.5) kPa). Three (43%) acidotic pregnant women fulfilled diagnostic criteria for RTA. All women recovered spontaneously within less 7 days.
Metabolic acidosis seems to be very common (85%) in pregnant critically ill COVID-19 patients, and the prevalence of RTA might be higher than normal. It remains to be demonstrated if this observation is an indirect epiphenomenon or due to a direct viral effect on the tubular epithelium.
肾小管酸中毒（RTA）是代谢性酸中毒极为罕见的病因（每10万人中10例）。RTA与妊娠及重症冠状病毒病2019（COVID-19）均无关联。本研究旨在分析危重症COVID-19孕妇中正常阴离子间隙代谢性酸中毒的患病率及临床病程，并与年龄匹配的非妊娠女性患者队列进行比较。
对2020年2月至2021年4月期间连续入住三级重症监护病房（ICU）的危重症COVID-19患者的前瞻性观察队列进行二次分析。
共有321例COVID-19患者需入住ICU；95例（30%）为女性，18例（19%）为育龄期女性。8名孕妇中有7名（88%）（均处于妊娠晚期）因COVID-19需要高级呼吸支持。估计肾小球滤过率为135（123 - 158）mL/min/1.73m²体表面积，6名孕妇（86%）被诊断为正常、呼吸代偿性阴离子间隙代谢性酸中毒（pH值7.3（7.18 - 7.31），HCO₃⁻ 14.8（12.8 - 18.6）mmol/L，paCO₂ 3.4（3.3 - 4.5）kPa）。3名（43%）酸中毒孕妇符合RTA诊断标准。所有女性均在7天内自发康复。
危重症COVID-19孕妇中代谢性酸中毒似乎非常常见（85%），RTA的患病率可能高于正常水平。这一观察结果是间接的附带现象还是由于病毒对肾小管上皮的直接作用，仍有待证实。
Zotero 插件