The experience of using succinate-containing crystalloid solution in the correction of COVID-19-associated endotheliopathy

BACKGROUND: Early experience with succinate-containing agents has demonstrated their effectiveness in controlling COVID-19-related systemic disease and coagulopathy. The work is aimed at studying the possibilities of infusion correction of COVID-19-associated endotheliopathy. AIM: To evaluate the effect of using meglumine sodium succinate 1.5% solution on the severity of COVID-19-associated endotheliopathy in patients with severe coronavirus infection. MATERIALS AND METHODS: Clinical and laboratory parameters of 53 patients in the intensive care unit with COVID-19 complicated by community-acquired bilateral polysegmental pneumonia were analyzed. The intensive care package for 27 patients (study group) included a daily infusion of a 1.5% solution of meglumine sodium succinate (Reamberin) in a daily dose of up to 10 ml/kg for a course of at least 11 days or during the entire stay in the department. The control group, which included 26 patients, received a similar volume of Ringer’s solution. At all stages of the study, the level of endotheliocytosis, homocysteine, fibrinogen, activated partial thromboplastin time, platelet count, and antithrombin III was determined. RESULTS: Assessment of the degree of endotheliopathy in the meglumine succinate group showed a significant decrease in the initially elevated levels of endothelemia and homocysteinemia at all stages of the study. The pattern of changes in the study group highly correlated (r values were in the range 0.90–0.96) with the dynamics of fibrinogenemia, platelet levels, and antithrombin III. CONCLUSIONS: The use of a succinate-containing infusion solution in patients with a new coronavirus infection promotes a more rapid and sustainable correction of COVID-19-associated endotheliopathy, which, in turn, is manifested by a decrease in the levels of endotheliocytosis, secondary markers of endotheliopathy, a platelet-protective effect and a decrease in heparin resistance.