Subject(s)
COVID-19 , Humans , COVID-19/complications , COVID-19/epidemiology , Lung , Pulmonary Gas ExchangeABSTRACT
Background: A computational proteomic analysis suggested that SARS-CoV-2 might bind to hemoglobin (Hb). The authors hypothesized that this phenomenon could result in a decreased oxygen (O2) binding and lead to hemolytic anemia as well. The aim of this work was to investigate whether the affinity of Hb for O2 was altered during COVID-19. Methods: In this retrospective, observational, single-center study, the blood gas analyses of 100 COVID-19 patients were compared to those of 100 non-COVID-19 patients. Fifty-five patients with carboxyhemoglobin (HbCO) ≥8% and 30 with sickle cell disease (SCD) were also included ("positive controls" with abnormal Hb affinity). P50 was corrected for body temperature, pH, and PCO2. Results: Patients did not differ statistically for age or sex ratio in COVID-19 and non-COVID-19 groups. Median P50 at baseline was 26 mmHg [25.2-26.8] vs. 25.9 mmHg [24-27.3], respectively (p = 0.42). As expected, P50 was 22.5 mmHg [21.6-23.8] in the high HbCO group and 29.3 mmHg [27-31.5] in the SCD group (p < 0.0001). Whatever the disease severity, samples from COVID-19 to non-COVID-19 groups were distributed on the standard O2-Hb dissociation curve. When considering the time-course of P50 between days 1 and 18 in both groups, no significant difference was observed. Median Hb concentration at baseline was 14 g.dl-1 [12.6-15.2] in the COVID-19 group vs. 13.2 g.dl-1 [11.4-14.7] in the non-COVID-19 group (p = 0.006). Among the 24 COVID-19 patients displaying anemia, none of them exhibited obvious biological hemolysis. Conclusion: There was no biological argument to support the hypothesis that SARS-CoV-2 could alter O2 binding to Hb.
ABSTRACT
RESUME Depuis mi-mars 2020, l’épidémie de COVID-19 a conduit à la suspension de la prise en charge des patients présentant des troubles du sommeil et de la vigilance. Bien qu’ayant rarement un caractère urgent, cette prise en charge ne peut être repoussée indéfiniment. Des propositions visant à établir les modalités de reprise progressive des activités de médecine du sommeil ont été élaborées grâce à la méthodologie CORE qui permet de dégager rapidement un consensus d’experts lorsque les données probantes sont insuffisantes. La réalisation d’explorations diagnostiques du sommeil et de la vigilance, doit être limitée aux patients pour lesquels la balance bénéfice-risque est favorable de manière indiscutable et lorsque les résultats sont susceptibles d’avoir un impact décisif sur une stratégie thérapeutique, en privilégiant la téléconsultation et les enregistrements ambulatoires. Le strict respect de la distanciation physique et des autres mesures barrière, le port d’équipement de protection par le personnel en fonction des tâches, l’utilisation de matériel à usage unique si possible, et des procédures rigoureuses de nettoyage et de désinfection de l’équipement et des locaux doit permettre de limiter les risques de transmission du SARS-CoV-2 entre le patient et les soignants. Les propositions du groupe d’experts sont valables au moment de leur publication mais seront bien entendu réévaluées et complétées très régulièrement en fonction de l’évolution des connaissances scientifiques et des recommandations des autorités de santé basées sur l’évolution de l’épidémie. SUMMARY Since mid-March 2020, the COVID-19 epidemic has led to the suspension of sleep clinic and sleep center operations. Although rarely urgent, sleep disorder management cannot be postponed indefinitely. Proposals to clarify the modalities for the gradual resumption of sleep medicine services have been developed using the CORE methodology, which allows for rapid expert consensus when the evidence-based data is weak. The performance of diagnostic sleep and alertness tests must be limited to patients for whom the benefit-risk balance is indisputably favorable and when the results are likely to have a decisive impact on a therapeutic strategy, with priority being given to teleconsultation and ambulatory recordings. Strict adherence to physical separation and other barrier measures, the use of protective equipment by staff and of single-use equipment whenever possible, and strict cleaning and disinfection procedures for equipment and premises should limit the risk of SARS-CoV-2 transmission between patient and staff members. The proposals of the expert group are valid at the time of their publication but will be re-evaluated and updated regularly according to the development of scientific knowledge and the recommendations of the health authorities based on the evolution of the epidemic.