3. Discussion
SARS-CoV-2 infection, pulmonary interstitial edema, hyperkaliemia, inflammation, hyponatremia, infections, infection, acute lung injury, hyperkalemia, lung tissue damage, hypovolemia
VIRUS, SARS-COV-2 INFECTION, ISCHEMIC HEART DISEASE, SIDE EFFECT, ADVERSE EVENTS, COVID-19 PNEUMONIA, DISEASE, INFLAMMATION, INFECTIONS, HYPONATREMIA, INFECTION, COMPLICATIONS, INFLAMMATORY RESPONSE
The increasing number of infections with the SARS-CoV-2 virus has created the need not only to treat the disease itself but also to develop a way to prevent long-term complications of infection deriving from immunological imbalance. In our study, we evaluated the effects of potassium canrenoate on inflammatory markers in the treatment of COVID-19.There were no significant differences between the placebo and potassium canrenoate regarding CD3+ blood cell or CD4+ lymphocyte percentage, IL-1ß, IL-2, TNF-α positive cell percentage in general, or lymphocytes specifically on day 1 or on day 7. Similarly, the levels of Il-6 between the group did not differ in terms of statistical significance. However, the level of Il-6 between the placebo group and the intervention was higher in the intervention group on day 1 (46.68 ± 56.79 pg/mL vs. 64.97 ± 72.52 pg/mL, IL-6 is a cytokine characterized by its pro-inflammatory and pro-fibrotic properties. It plays a role in the development of pulmonary interstitial edema and triggers a severe inflammatory response by activating neutrophils and facilitating their accumulation at the injury site. This, in turn, leads to the release of both proteases and oxygen-free radicals, contributing to the overall inflammatory process [While our study did not demonstrate a statistically significant benefit of administering additional potassium canrenoate therapy to patients with moderate to severe COVID-19 pneumonia, it is important to consider several potential explanations for this outcome. Spironolactone is one of the inhibitors of the renin–angiotensin–aldosterone (RAA) system, particularly preferred in COVID-19 [There have been reports suggesting a potential beneficial effect of potassium canrenoate in mitigating endothelial inflammation in individuals with SARS-CoV-2 infection [The optimal timing and duration of potassium canrenoate intervention for COVID-19 pneumonia remain uncertain. In our study, patient inclusion was contingent upon having a blood oxygen saturation level below 94%, suggesting some degree of lung tissue damage. This criterion may have resulted in a delay in the timing of intervention. There is a legitimate concern that early immunomodulation could potentially suppress the host’s antiviral response and slow down viral clearance, whereas delayed immunomodulation may prove ineffective in the context of advanced acute lung injury [In our study, there was no significant increase in adverse events after administration of potassium canrenoate. Despite the reporting of some adverse events, such as hyperkaliemia, hyponatremia and hypovolemia, blood iron levels did not differ significantly between groups. Nevertheless, there was a trend towards hyperkalemia in the intervention group, which is the most common side effect of potassium canrenoate.This study is not without limitations. Firstly, although the study was randomized, it was single-center, which may have contributed to the occurrence of biases. Secondly, it should be noted that the study was relatively small and the number of patients who completed the study was small. Thirdly, apart from the cytokines evaluated by our group (CD3+ blood cell or CD4+ lymphocyte percentage and IL-1ß, IL-2, TNF-α-positive cell percentage in general and on lymphocytes), other factors should be evaluated in future trials, including TGF-β, MMP-1 or MMP-7. Moreover, there was a significantly higher rate of ischemic heart disease in the placebo group, which might have affected the study results. Although some positive trends were observed in the potassium canrenoate group, none of these observations reached statistical significance. Further studies in a larger group of patients are needed to confirm the possible protective effect of potassium canrenoate.