BACKGROUND:COVID-19, sepsis, and septic shock are associated with significant endothelial dysfunction and capillary leakage, posing diagnostic and management challenges in critically ill patients. Capillary leakage, as reflected by the albumin transudation rate (ATR), may have implications for fluid dynamics and patient outcomes in these conditions. We sought to describe and compare ATR in these two related pathologies, but clinically distinct conditions.
METHODS:This study was conducted in 2022 across three ICUs and included 36 patients (18 with COVID-19 and 18 with sepsis). The local ethical committees approved the study. ATR, total blood volume (TBV), red blood cell volume (RBCV), and plasma volume (PV) were measured at multiple time points (Days 1, 2, 3, 7, and 10) using a 131I-albumin tracer. Data were analyzed using the non-parametric Wilcoxon rank-sum test and multivariate linear regression to identify predictors of ATR.
RESULTS:ATR was significantly higher in patients with sepsis compared to those with COVID-19 throughout the ICU stay, despite lower admission severity scores in the sepsis group. Clinical assessments of the volume status frequently misclassify TBV in patients with COVID-19 or sepsis. Patients were often deemed hypervolemic when, by objective measures, they were hypovolemic under both conditions.
CONCLUSION:ATR was persistently elevated in critically ill patients with sepsis and COVID-19. Sepsis exhibited significantly higher ATR values, suggesting a more pronounced endothelial dysfunction. There is a frequent inaccuracy in clinical fluid status assessment, which demands more reliable diagnostic tools to better guide fluid therapy in critically ill patients.