Potential for infusion correction of COVID-19-associated endotheliopathy

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Abstract

Aim. To evaluate the relationship between the systemic inflammatory response and the severity of COVID-19-associated endotheliopathy and the effect of succinate-containing crystalloid solution (sodium meglumine succinate) on it in patients with severe COVID-19.

Materials and methods. Clinical and laboratory parameters of 53 intensive care unit's patients with COVID-19 complicated by community-acquired bilateral multisegmental pneumonia were analyzed. Intensive therapy complex of 27 patients (study group) included daily infusion of 1.5% solution of sodium meglumine succinate (Reamberin) in the daily dose of 10 ml/kg for at least 11 days (or during the whole stay in the unit). A similar volume of Ringer's solution was present in the control group of 26 patients. The levels of endotheliocytosis, homocysteine, and systemic inflammatory response were determined at all stages of the study.

Results. The evaluation of endotheliopathy degree in the meglumine succinate group showed a significant reduction of initially elevated levels of endotheliemia and homocysteinemia at all study stages. The pattern of changes in the study group was highly correlated (r=0.90–0.96) with the dynamics of systemic inflammatory response parameters-fibrinogenemia, C-reactive protein and interleukin-6 levels. As normalization of the immune imbalance, we regarded the termination of lymphopenia in the Reamberin group.

Conclusion. Early inclusion of Reamberin infusion into intensive therapy of severe COVID-19, in comparison with Ringer's solution, leads to significant and stable correction of the severity of systemic inflammatory response, which in turn is naturally reflected in the severity of endothelial dysfunction, multiple organ failure, and also leads to a decrease in 28-day mortality.

About the authors

Ionas S. Simutis

Sokolov North-Western District Scientific and Clinical Center; Mechnikov North-Western State Medical University

Author for correspondence.
Email: simutis@mail.ru
ORCID iD: 0000-0002-2537-0142

д-р мед. наук, зав. отд-нием реанимации ФГБУ «СЗОНКЦ им. Л.Г. Соколова», доц. каф. анестезиологии и реаниматологии им. В.Л. Ваневского ФГБОУ ВО «СЗГМУ им. И.И. Мечникова»

Russian Federation, Saint Petersburg; Saint Petersburg

Viacheslav A. Ratnikov

Sokolov North-Western District Scientific and Clinical Center

Email: simutis@mail.ru
ORCID iD: 0000-0002-9645-8408

д-р мед. наук, проф., зам ген. дир – мед. дир. ФГБУ «СЗОНКЦ им. Л.Г. Соколова»

Russian Federation, Saint Petersburg

Alexey N. Scheglov

Central Clinical Hospital with a Polyclinic

Email: oper@mtd122.com
ORCID iD: 0000-0002-3783-7918

канд. мед. наук, врач отд-ния оториноларингологии ФГБУ «ЦКБ с поликлиникой» Управления делами Президента РФ

Russian Federation, Moscow

Olga V. Nikolaeva

Mechnikov North-Western State Medical University

Email: simutis@mail.ru
ORCID iD: 0009-0005-4915-5286

ординатор каф. анестезиологии и реаниматологии им. В.Л. Ваневского ФГБОУ ВО «СЗГМУ им. И.И. Мечникова»

Russian Federation, Saint Petersburg

Gennady A. Boyarinov

Privolzhsky Research Medical University

Email: simutis@mail.ru
ORCID iD: 0000-0002-7557-0564

д-р мед. наук, проф., проф. каф. анестезиологии, реаниматологии и трансфузиологии ФГБОУ ВО ПИМУ

Russian Federation, Nizhniy Novgorod

Alexander A. Sapegin

Sokolov North-Western District Scientific and Clinical Center

Email: simutis@mail.ru
ORCID iD: 0000-0002-6433-2659

канд. мед. наук, зав. клинико-диагностической лаб., врач клин. лабораторной диагностики ФГБУ «СЗОНКЦ им. Л.Г. Соколова»

Russian Federation, Saint Petersburg

Larisa B. Gaikovaya

Mechnikov North-Western State Medical University

Email: simutis@mail.ru
ORCID iD: 0000-0003-1000-1114

д-р мед. наук, доц., зав. каф. биологической и общей химии им. В.В. Соколовского, зав. центральной клинико-диагностической лаб. ФГБОУ ВО «СЗГМУ им. И.И. Мечникова»

Russian Federation, Saint Petersburg

Darya A. Evteeva

Mechnikov North-Western State Medical University

Email: simutis@mail.ru
ORCID iD: 0000-0001-5756-2088

заочный аспирант каф. биологической и общей химии им. В.В. Соколовского, врач клин. лабораторной диагностики центральной клинико-диагностической лаб. ФГБОУ ВО «СЗГМУ им. И.И. Мечникова»

Russian Federation, Saint Petersburg

Ksenia N. Zamyatina

Mechnikov North-Western State Medical University

Email: simutis@mail.ru
ORCID iD: 0000-0002-6890-6357

заочный аспирант каф. биологической и общей химии им. В.В. Соколовского, врач клин. лабораторной диагностики центральной клинико-диагностической лаб. ФГБОУ ВО «СЗГМУ им. И.И. Мечникова»

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Dynamics of C-reactive venous blood protein in patients.

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3. Fig. 2. Dynamics of interleukin-6 venous blood level in patients.

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4. Fig. 3. Endothelium level in patients.

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5. Fig. 4. Homocysteine concentration dynamics in patients.

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6. Fig. 5. Dynamics of fibrinogen concentration in patients.

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7. Fig. 6. Dynamics of lymphocyte level of venous blood in patients.

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8. Fig. 7. Neutrophilic-lymphocytic index dynamics in patients.

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