Carboxyhemoglobinemia in Critically Ill Coronavirus Disease 2019 Patients
Hina Faisal1, Syeda T Ali1, Jiaqiong Xu2
1Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA.
Insights
Carboxyhemoglobinemia in COVID-19 patients stems from sepsis, hemolysis, and cytokine storm, not direct viral virulence. Routine monitoring of carboxyhemoglobin (COHb) levels is recommended for critically ill patients.
Area of Science:
- Medical Research
- Infectious Diseases
- Critical Care Medicine
Background:
- Carboxyhemoglobinemia, an increase in carboxyhemoglobin (COHb) levels, is a serious condition with limited data in coronavirus disease 2019 (COVID-19) patients.
- Understanding the causes and prevalence of COHb elevation in COVID-19 is crucial for effective patient management.
Purpose of the Study:
- To evaluate the incidence and etiologies of carboxyhemoglobinemia in hospitalized COVID-19 patients.
- To determine the association between carboxyhemoglobinemia and COVID-19 infection.
- To assess the reliability of pulse oximetry in COVID-19 patients with elevated COHb.
Main Methods:
- A retrospective chart review was conducted at an academic medical center.
- Inclusion criteria: inpatient COVID-19 cases with recorded carboxyhemoglobin (COHb) levels between March 2020 and August 2020.
- COHb levels were measured using a CO-oximeter.
Main Results:
- Carboxyhemoglobinemia in COVID-19 patients was attributed to sepsis, hemolysis, and cytokine storm, sequelae of the infection, rather than direct viral virulence.
- A high incidence of carboxyhemoglobinemia was observed in critically ill COVID-19 patients.
- No uniform results were found regarding the discrepancy between pulse oximetry and arterial blood gas measurements in these patients.
Conclusions:
- Elevated carboxyhemoglobin levels in COVID-19 patients are likely secondary to the systemic inflammatory response and complications, not solely due to the virus's direct impact.
- Routine monitoring of carboxyhemoglobin (COHb) levels is recommended for critically ill COVID-19 patients to facilitate timely and effective treatment.
- The study highlights the complexity of managing critically ill COVID-19 patients with coexisting conditions affecting COHb levels.
Abstract:
Carboxyhemoglobinemia is a common but a serious disorder, defined as an increase in carboxyhemoglobin level. Unfortunately, there are few data on carboxyhemoglobinemia in coronavirus disease 2019 (COVID-19) patients. Therefore, our study aimed to evaluate the incidence and etiologies of carboxyhemoglobinemia in COVID-19 patients and determine any association between carboxyhemoglobinemia and novel coronavirus infection. A retrospective chart review was performed at an academic medical center for all inpatient COVID-19 cases with either single or serial carboxyhemoglobin (COHb) levels from March 2020 through August 2020.Our study demonstrates that carboxyhemoglobinemia in COVID-19 patients is due to sepsis, hemolysis, and cytokine storm, triggered by the novel coronavirus infection sequela and is not directly from the virulence of novel coronavirus. Given the coexisting illnesses in critically ill COVID-19 patients, it is impossible to establish if coronavirus virulence was the culprit of elevated COHb levels. Moreover, our study found a high incidence of carboxyhemoglobinemia in critically ill COVID-19 patients. The oxygen saturation measured by pulse oximetry can be inaccurate and unreliable; however, our study could not demonstrate any uniform results on the discrepancy between oxygen saturation measured by pulse oximetry and arterial blood gas. In this study, COHb levels were measured using a CO-oximeter. Therefore, we recommend monitoring the COHb level routinely in critically ill COVID-19 patients to allow more effective and prompt treatment.
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