ABSTRACT
Objective. To evaluate the effect of succinate-containing crystalloid solution (sodium meglumin succinate) on the severity of endothelial dysfunction in patients with severe COVID-19. Material and methods. The study included 53 patients with severe form of COVID-19 complicated by bilateral polysegmental pneumonia. All patients are initially, by the method of envelopes, randomized into two groups. In the study group (27 patients), the intensive care complex includes daily infusion of Reamberin (1.5% solution of meglumin sodium succinate), in a daily dose of 10 ml/kg for 4 hours for up to 11 days (or time spent in the intensive care unit). Patients of the control group (26 patients) received Ringer's solution in the same volume. Endotheliocytosis, homocysteine concentration, platelet levels and coagulation tests were studied in dynamics. Results and discussion. Assessment of the severity of endothelial dysfunction showed that the study group determined a more significant (p<0.05) decrease in initially elevated levels of endothelial cytosis and homocysteine concentration at all stages of the study. Significant intergroup differences have manifested since the second day of observation. Infusion correction of the severity of endothelial dysfunction led to a decrease in the frequency of thrombotic complications, the probability of conversion to an invasive ventilator and mortality compared to the traditional approach. Conclusion. The use of a succinate-containing crystalloid solution (sodium meglumin succinate) in the complex therapy of severe forms of NCI is justified by a more significant and persistent correction of the initially pronounced endothelial dysfunction, leading to a decrease in the number of thrombotic complications, transfers to invasive ventilator and mortality. © 2022, Media Sphera Publishing Group. All rights reserved.
ABSTRACT
Aim of the study: to evaluate the effect of meglumine sodium succinate (MSS) on the efficacy of anticoag-ulant therapy in patients with severe COVID-19 infection complicated by bilateral community-acquired pneu-monia. Materials and methods. Overall efficacy of treatment was analyzed in 12 patients hospitalized to ICU with the diagnosis of severe confirmed COVID-19 coronavirus infection (U07.1) complicated by bilateral multiseg-mental pneumonia. All patients received prophylactic anticoagulation with unfractionated heparin. The patients were divided into two groups: 7 of them received a multi-electrolyte solution containing MSS 5 ml/kg daily for the entire ICU stay (3-10 days) as a part of therapy;5 patients received a similar volume of a conven-tional multi-electrolyte solution containing no metabolically active substrates and comprised a control group. Coagulation parameters were measured in arterial and venous blood of all patients at the following stages: 1) upon admission to the ICU;2) 2-4 hours after the first dose of heparin;3) 8-12 hours after the second dose of heparin;4) 24 hours after the beginning of intensive therapy. On the 28th day of follow-up, mortality, duration of ICU stay, and incidence of thrombotic complications in the groups were evaluated. Nonparametric methods of statistical analysis were used to assess intragroup changes and intergroup differences. Results. The group of patients administered with MSS had significantly fewer thromboembolic events during 28 days of treatment and shorter ICU stay. These patients responded faster to anticoagulant therapy, which was suggested by more distinct changes in coagulation parameters, i.e. increased APTT, persisting viable thrombocyte population, reduced D-dimer and fibrinogen levels. Conclusion. The metabolic action of succinate possibly increases endothelial resistance to damaging factors and reduces its procoagulant activity. The hypothesis requires testing in a larger clinical study with a design including laboratory evaluation of the efficacy of varying doses of the studied drug as well as aiming at eluci-dation of the mechanisms of its effect on specific pro-and anticoagulation system components.
ABSTRACT
Aim. To assess the effect of meglumine sodium succinate on the effectiveness of basic therapy in correcting gas exchange abnormalities in patients with severe COVID-19 infection complicated by bilateral community-acquired pneumonia. Methods. The analysis of the effectiveness of therapy of 12 patients with a diagnosis of "New coronavirus infection COVID-19 (confirmed), severe form U07.1. Complication: Bilateral multifocal pneumonia" was carried out. The patients were divided into two groups: 7 received, as part of standard therapy, a solution of meglumine sodium succinate in a daily dose of 5 ml/kg during stay in the intensive care unit;5 patients received a similar volume of Ringer's solution and formed the control group. In the arterial and venous blood of all patients, the indicators of acid-base state and water-electrolyte balance, glycemia and lactatemia were measured at several stages: (1) at admission to the intensive care unit, (2) 2-4 hours after the start of intensive therapy, (3) after 8-12 hours, (4) after 24 hours. On the 28th day of observation, mortality, the duration of treatment in the intensive care unit and the incidence of thrombotic complications in the groups were assessed. The Friedman nonparametric hypothesis test was used to assess intragroup dynamics, and the nonparametric Mann-hitney U test for intergroup comparisons. Results. In the group of patients who received meglumine sodium succinate, there was a significant decrease in the incidence of thromboembolic events during 28 days of treatment: Myocardial ischemia event rate ratio from 0.89 [95% confidence interval (CI) 0.19-1.16] in the control group to 0.55 (95% CI 0.06-0.81) in the study group at p=0.043;pulmonary embolism event from 0.50 (95% CI 0-1.0) in the control group to 0.28 (95% CI 0-1.0) in the study group at p=0.041. There was also a decrease in the duration of intensive care unit length of stay to 6.1±1.1 days in the study group versus 8.9±1.3 days in the control group. Conclusion. Compared with standard infusion therapy, the use of meglumine sodium succinate leads to a faster normalization of ventilation-perfusion ratios in patients with severe coronavirus infection. © 2021 Eco-Vector LLC. All rights reserved.