Skip to main content

ORIGINAL RESEARCH article

Front. Mol. Biosci.
Sec. Cellular Biochemistry
Volume 11 - 2024 | doi: 10.3389/fmolb.2024.1510592

The role of neutrophilia in hyperlactatemia, blood acidosis, impaired oxygen transport, and mortality outcome in critically ill COVID-19 patients

Provisionally accepted
Basma A. Yasseen Basma A. Yasseen 1Aya A. Elkhodiry Aya A. Elkhodiry 1Hajar El-Sayed Hajar El-Sayed 1Mona Zidan Mona Zidan 1Azza Kamel Azza Kamel 1Mohamed A Badawy Mohamed A Badawy 1Marwa Hamza Marwa Hamza 2Riem M El-Messiery Riem M El-Messiery 3Mohamed Elansary Mohamed Elansary 4Engy Ahmed Abdel-rahman Engy Ahmed Abdel-rahman 1,5Sameh Saad Ali Sameh Saad Ali 1*
  • 1 Children’s Cancer Hospital (Egypt), Zenab, Cairo, Egypt
  • 2 Department of Clinical Pharmacy, Faculty of Pharmacy, The British University in Egypt, El Sherouk City, Beni Suef, Egypt
  • 3 Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Beni Suef, Egypt
  • 4 Department of Intensive Care, Faculty of Medicine, Cairo University, Cairo, Cairo, Egypt
  • 5 Department of Pharmacology, Faculty of Pharmacy, Assiut University, Asyut, Asyut, Egypt

The final, formatted version of the article will be published soon.

    Introduction: COVID-19 severity and high in-hospital mortality are often associated with severe hypoxemia, hyperlactatemia, and acidosis, yet the key players driving this association remain unclear. It is generally assumed that organ damage causes toxic acidosis, but since neutrophil numbers in severe COVID-19 can exceed 80% of the total circulating leukocytes, we asked if metabolic acidosis mediated by the glycolytic neutrophils is associated with lung damage and impaired oxygen delivery in critically ill patients.Methods: Based on prospective mortality outcome, critically ill COVID-19 patients were divided into ICUsurvivors and ICU-non-survivors. Samples were analyzed to explore if correlations exist between neutrophil counts, lung damage, glycolysis, blood lactate, blood pH, hemoglobin oxygen saturation, and mortality outcome. We also interrogated isolated neutrophils, platelets, and PBMCs for glycolytic activities.Results: Arterial blood gas analyses showed remarkable hypoxemia in non-survivors with no consistent differences in PCO2 or [HCO3 -]. The hemoglobin oxygen dissociation curve revealed a right-shift, consistent with lower blood-pH and elevated blood lactate in non-survivors. Metabolic analysis of different blood cells revealed increased glycolytic activity only when considering the total number of neutrophils.Conclusion: This indicates the role of neutrophilia in hyperlactatemia and lung damage, subsequently contributing to mortality outcomes in severe SARS-CoV-2 infection.

    Keywords: Lung damage, COVID-19 mortality, Neutrophils, Lactate, Acidosis

    Received: 13 Oct 2024; Accepted: 03 Dec 2024.

    Copyright: © 2024 Yasseen, Elkhodiry, El-Sayed, Zidan, Kamel, Badawy, Hamza, El-Messiery, Elansary, Abdel-rahman and Ali. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Sameh Saad Ali, Children’s Cancer Hospital (Egypt), Zenab, Cairo, Egypt

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.