Letter to the Director
Reply to “Absence of Relevant Clinical Effects of SARS-CoV-2 on the Affinity of Hemoglobin for O2 in Patients With COVID-19”
Respuesta a «Ausencia de efectos clínicos destacables del SARS-CoV-2 sobre la afinidad de la hemoglobina por el O2 en pacientes con COVID-19»
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"apellidos" => "Rodríguez-Chiaradia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:4 [ "nombre" => "Joaquim" "apellidos" => "Gea" "email" => array:1 [ 0 => "Quim.gea@upf.edu" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital del Mar – IMIM, Departamento MELIS, Universitat Pompeu Fabra, CIBERES, ISCiii, BRN, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Laboratorio de Referencia de Cataluña, El Prat de Llobregat, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta a «Ausencia de efectos clínicos destacables del SARS-CoV-2 sobre la afinidad de la hemoglobina por el O<span class="elsevierStyleInf">2</span> en pacientes con COVID-19»" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr1a.jpeg" ] 1 => array:1 [ "imagen" => "gr1b.jpeg" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the scientific letter from Prof. Böning et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> commenting on our article on the affinity of hemoglobin for oxygen in patients with COVID-19.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The aim of our study was to reply from a clinical point of view to the hypothesis generated by two basic research papers that suggested that the virus decreases this affinity by way of different mechanisms.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> We, like previous authors such as Gille et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and Laredo et al.,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> found that the virus appears to have little effect on the interaction of hemoglobin with oxygen. However, these results contrast with those published by other authors, such as Vogel et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> It is important for the management of patients that these discrepancies are clarified, since the clinical impact of this affinity affects the real value of PaO<span class="elsevierStyleInf">2</span> as an indicator of blood oxygenation. The dispersion of our data, which included hospitalized patients with COVID-19 of heterogeneous severity, prompted Prof. Böning's group of physiologists to suggest that a reduced affinity between hemoglobin and oxygen may be a particular problem in more serious patients. They also suggest that this may be caused by shifts in the oxygen–hemoglobin dissociation curve, due, for example, to changes in the concentration of 2–3 diphosphoglycerate (2.3-BPG). Unfortunately, we did not determine blood levels of this 1.3-diphosphoglycerate isomer, which, together with several other variables that were analyzed in our study (PaCO<span class="elsevierStyleInf">2</span>, pH, temperature), affects the shape of the above-mentioned curve. We reanalyzed our data, including only the group of patients admitted to the intensive care unit for lung involvement that led to respiratory failure (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>75, with a total of 343 arterial and 220 venous samples), but this procedure did not reveal any relevant discrepancies between measured and calculated saturation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), so we conclude that there does not appear to be a loss of normal affinity of hemoglobin for oxygen. The possible decrease in hemoglobin itself, another parameter that varies considerably among clinical studies,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> could be due to different causes, such as the viral disease itself, nutritional deficiencies, or the proinflammatory state of critical patients. Another cause could be the frequent repetition of laboratory tests in intensive care units,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> a practice that was particularly common for both healthcare and for research reasons in severe COVID-19 patients. However, the rate of anemia in our severe patients was 27.8% (mean hemoglobin 12.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.9<span class="elsevierStyleHsp" style=""></span>g/dl), even lower than in critical patients with other diseases.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> It should be noted here that our hospital was very restrictive with regard to blood draws for research: a single sample was drawn from each patient and competitively allocated among the various studies.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr1a.jpeg" ] 1 => array:1 [ "imagen" => "gr1b.jpeg" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sobre «Ausencia de efectos clínicos destacables del SARS-CoV-2 sobre la afinidad de la hemoglobina por el O<span class="elsevierStyleInf">2</span> en pacientes con COVID-19»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. 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Stanworth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.12143" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2013" "volumen" => "160" "paginaInicial" => "445" "paginaFinal" => "464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23278459" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005800000004/v5_202301090807/S0300289622001673/v5_202301090807/en/main.assets" "Apartado" => array:4 [ "identificador" => "93644" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Director/Carta al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005800000004/v5_202301090807/S0300289622001673/v5_202301090807/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289622001673?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 3 | 10 |
| 2024 October | 72 | 26 | 98 |
| 2024 September | 86 | 16 | 102 |
| 2024 August | 91 | 33 | 124 |
| 2024 July | 45 | 18 | 63 |
| 2024 June | 68 | 25 | 93 |
| 2024 May | 85 | 16 | 101 |
| 2024 April | 53 | 21 | 74 |
| 2024 March | 78 | 20 | 98 |
| 2024 February | 59 | 36 | 95 |
| 2024 January | 65 | 28 | 93 |
| 2023 December | 59 | 23 | 82 |
| 2023 November | 88 | 20 | 108 |
| 2023 October | 108 | 24 | 132 |
| 2023 September | 57 | 26 | 83 |
| 2023 August | 46 | 34 | 80 |
| 2023 July | 49 | 28 | 77 |
| 2023 June | 46 | 13 | 59 |
| 2023 May | 53 | 19 | 72 |
| 2023 April | 54 | 24 | 78 |
| 2023 March | 57 | 22 | 79 |
| 2023 February | 56 | 22 | 78 |
| 2023 January | 45 | 37 | 82 |
| 2022 December | 79 | 27 | 106 |
| 2022 November | 62 | 19 | 81 |
| 2022 October | 97 | 55 | 152 |
| 2022 September | 76 | 26 | 102 |
| 2022 August | 65 | 43 | 108 |
| 2022 July | 72 | 50 | 122 |
| 2022 June | 73 | 37 | 110 |
| 2022 May | 141 | 50 | 191 |
| 2022 April | 84 | 9 | 93 |
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