Background: During the outbreak of coronavirus disease 2019 (COVID-19) many studies have investigated laboratory biomarkers in management and prognostication of COVID-19 patients, however to date, few have investigated arterial blood gas (ABG), acid-base and blood pressure (BP) patterns. The aim of the study is to assess the ABG and acid-base patterns, BP findings and their association with the outcomes of COVID-19 patients admitted to an intensive care unit (ICU). Methods: A single-centre retrospective, observational study in a dedicated COVID-19 ICU in Cape Town, South Africa. Admission ABG, serum electrolytes, renal function and BP readings performed on COVID-19 patients admitted between 26 March and 2 June 2020 were analysed and compared between survivors and non-survivors. Results: A total of 56 ICU patients had admission ABG performed at the time of ICU admission. An alkalaemia (pH > 7.45) was observed in 36 (64.3%) patients. A higher arterial pH [median 7.48 (IQR: 7.45-7.51 vs. 7.46 (IQR: 7.40-7.48), p=0.049] and partial pressure of oxygen in arterial blood [PaO2; median 7.9kPa (IQR 7.3- 9.6) vs. 6.5kPa (IQR: 5.2-7.3), p=<0.001] were significantly associated with survival. Survivors also tended to have a higher systolic BP [median: 144mmHg (IQR: 134- 152) vs. 139mmHg (IQR: 125-142), p=0.078] and higher arterial HCO3 [median: 28.0mmol/L (IQR: 25.7- 28.8) vs. 26.3mmol/L (IQR: 24.3-27.9); p=0.059). Conclusions: The majority of the study population admitted to ICU had an alkalaemia on ABG. A higher pH and lower PaO2 on ABG analysis were significantly associated with survival.

Since the first cases of atypical pneumonia linked to the Huanan Seafood Wholesale Market in Wuhan, China, were described in late December 2019, the global landscape has changed radically. In March 2020, the World Health Organization declared COVID-19 a global pandemic, and at the time of writing this review, just over three million individuals have been infected with more than 200,000 deaths globally. Numerous countries are in 'lockdown', social distancing is the new norm, even the most advanced healthcare systems are under pressure, and a global economic recession seems inevitable. A novel coronavirus (SARS-CoV-2) was identified as the aetiological agent. From experience with previous coronavirus epidemics, namely the severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) in 2004 and 2012 respectively, it was postulated that the angiotensin-converting enzyme-2 (ACE2) receptor is a possible port of cell entry. ACE2 is part of the renin-angiotensin system and is also associated with lung and cardiovascular disorders and inflammation. Recent studies have confirmed that ACE2 is the port of entry for SARS-CoV-2. Male sex, advanced age and a number of associated comorbidities have been identified as risk factors for infection with COVID-19. Many high-risk COVID-19 patients with comorbidities are on ACE inhibitors and angiotensin receptor blockers, and this has sparked debate about whether to continue these treatment regimes. Attention has also shifted to ACE2 being a target for future therapies or vaccines against COVID-19. In this review, we discuss COVID-19 and its complex relationship with ACE2.

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Background Glycated proteins, such as glycated haemoglobin (HbA1c) and glycated albumin (GA%), are increasingly being used for glycaemic control assessment and the diagnosis of diabetes mellitus. GA% is an intermediate marker of glycaemic control that is not influenced by factors that affect HbA1c concentrations. The aim of this study was to determine reference intervals and assess confounding factors for glycated albumin in a well-characterized healthy population in South Africa. Methods We measured glycated albumin using an enzymatic method on stored serum samples of healthy individuals recruited in Cape Town, South Africa. Reference intervals (overall and specific for age, sex and ethnicity) were determined using non-parametric methods and confounding factors were assessed using multiple regression analysis. Results The reference interval (2.5th to 97.5th percentile) for glycated albumin of 663 healthy individuals (mean age, 34 years, 38.6% males) ranged from 10.7 to 15.2%. Sex, body mass index categories and ethnicity were significantly associated with the glycated albumin and were considered of practical importance because their standardized regression coefficients (Beta) were greater than a cut-off of 0.15, implying a stronger effect on glycated albumin ( P < 0.001). The glycated albumin reference intervals for subjects with body mass index <25 kg/m2 was 11.2–15.3%, for body mass index 25–30 kg/m2 it was 10.5–14.9% and 10.0–14.6% for body mass index >30 kg/m2 ( P = 0.0001). Conclusions The overall reference interval showed good correlation with reference intervals determined in other studies. However, sex, ethnicity and body mass index were statistically significant confounding factors that may influence the overall reference interval. Therefore, overall glycated albumin reference intervals should be used cautiously.