• L Lorente, F Gómez-Bernal, M M Martín, J A Navarro-Gonzálvez, M Argueso, A Perez, L Ramos-Gómez, J Solé-Violán, J A Marcos Y Ramos, N Ojeda, A Jiménez, and Working Group on COVID-19 Canary ICU.
• Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. Electronic address: lorentemartin@msn.com.
• Med Intensiva. 2020 Nov 10.

ObjectiveHigher blood nitrate and nitrite levels have been found in coronavirus disease 2019 (COVID-19) patients than in healthy subjects. The present study explores the potential association between serum nitrate levels and mortality in COVID-19 patients.DesignA prospective observation study was carried out.SettingEight Intensive Care Units (ICUs) from 6 hospitals in the Canary Islands (Spain).PatientsCOVID-19 patients admitted to the ICU.InterventionsDetermination of serum nitrate levels at ICU admission.Main Variable Of InterestMortality at 30 days.ResultsNon-surviving (n=11) compared to surviving patients (n=42) showed higher APACHE-II (p<0.001) and SOFA scores (p=0.004), and higher serum nitrate levels (p=0.001). Logistic regression analyses showed serum nitrate levels to be associated to 30-day mortality after controlling for SOFA (OR=1.021; 95%CI=1.006-1.036; p=0.01) or APACHE-II (OR=1.023; 95%CI=1.006-1.041; p=0.01). There were no differences in the area under the curve (AUC) for mortality prediction by serum nitrate levels (AUC=83%; 95%CI=73-92%; p<0.001), APACHE II (AUC=85%; 95%CI=75-96%; p<0.001) and SOFA (AUC=78%; 95%CI=63-92%; p=0.005) based on the DeLong method. The Kaplan-Meier analysis found patients with serum nitrates levels>68.4μmol/l to have a higher mortality rate (hazard ratio=138.8; 95%CI=22.3-863.9; p<0.001).ConclusionsThe main novel finding was the association between serum nitrate levels and mortality in COVID-19 patients controlling for the SOFA or APACHE-II scores, though larger studies are needed to confirm this observation.Copyright © 2020 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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