Diagnosing metabolic disorders at hospital admission in patients with COVID-19 to evaluate the risk of bacterial sepsis: a retrospective analysis

BACKGROUND: Sepsis is one of the most common life-threatening complications of COVID-19 occurring in 20% to 52% of hospitalized patients by various estimates. Lactate levels in combination with refractory hypotension are part of the criteria for septic shock and are widely used for predicting bacterial sepsis. However, the contribution of the lactate levels as a risk factor for sepsis in COVID-19 remains unclear.

AIM: To establish the association between the onset of sepsis in COVID-19 and the baseline values of lactate, glucose, and lactate dehydrogenase at admission to the specialized hospital department.

MATERIALS AND METHODS: A retrospective study was based at N.A. Semashko Regional Clinical Hospital in Nizhny Novgorod and included 11,647 patients with confirmed COVID-19.

RESULTS: Hyperlactatemia was found in 7,945 patients, accounting for 68.2% of all admissions. Later on, sepsis was diagnosed in 627 (5.4%) of those, while baseline hyperlactatemia was observed in 515 patients (82.1%). Most patients who had baseline hyperlactatemia and developed sepsis during the hospital stay also demonstrated higher lactate dehydrogenase and glucose levels at baseline. Baseline hyperlactatemia of 4.1 to 6.0 mmol/L and >6.0 mmol/L was found to be significantly associated with a higher incidence of sepsis: 3.6 times ( p =0.00004) and 6 times ( p =0.00001) higher, respectively. In 2.0 to 4.0 mmol/L baseline hyperlactatemia, sepsis was not any more frequent than in patients with normal lactate levels at admission. Baseline hyperglycemia resulted in 2.18-fold higher incidence of sepsis ( p =0.00012), and elevated baseline lactate dehydrogenase raised the probability of sepsis by 2.37 times ( p =0.00011).

CONCLUSION: Abnormal metabolism parameters at admission are associated with sepsis in patients with moderate COVID-19.