Abstract
Introduction/Aim: Hyponatremia (serum sodium <135 mEq/L) portends a worse prognosis in patients with community-acquired pneumonia. Data regarding the outcome of hyponatremia in hospitalized COVID-19 patients are insufficient and controversial. The present study aimed to identify the predictors of hyponatremia and its impact on clinical outcome measures in hospitalized COVID-19 patients.
Material and Method: We conducted a retrospective study on 787 adult patients with SARS-CoV-2 infection admitted to a university hospital between March 10, 2020, and December 15, 2020, February. Demographic and laboratory features, comorbid diseases, medications, radiology results, and clinical outcome measures of the patients were obtained retrospectively from their medical records.
Findings: One hundred fifty-nine (20.2%) patients out of 787 had hyponatremia. Hyponatremia was mild (sodium: 130 -134 mEq/L) in majority of cases (n=124). The severity of pneumonia (p = 0.013) and having diabetes (p > 0.001) were the independent predictors of hyponatremia at the time of admission. The median length of hospital stay (LOS) was longer in patients with hyponatremia than patients with normonatremia (10 days vs. 8 days, p < 0.001). In multivariate analysis, hyponatremia was significantly associated with ICU admission or the need for mechanical ventilation (adjusted OR, 1.72; 95% confidence interval [95% CI], 1.03 to 2.85; p = 0.036). The severity of pneumonia, hemoglobin and lactate dehydrogenase levels, neutrophil-to-lymphocyte ratio (NLR), and body temperature were also associated with ICU admission or the need for mechanical ventilation. The oxygen saturation, male sex, serum albumin, NLR, and the ICU admission but not the hyponatremia on admission were significantly related to mortality.
Conclusion: Hyponatremia on admission, even when mild, predicts a worse outcome in COVID-19 patients, and it should be considered in risk stratification.
Keywords
Supporting Institution
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References
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- COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med 2021; 47: 60-73.
- Suleyman G, Fadel RA, Malette KM, et al. Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in Metropolitan Detroit. JAMA Netw Open 2020; 3: e2012270.
- Bellan M, Patti G, Hayden E, et al. Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients. Sci Rep 2020; 10: 20731.
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- Fucà G, Mariani L, Lo Vullo S, et al. Weighing the prognostic role of hyponatremia in hospitalized patients with metastatic solid tumors: the HYPNOSIS study. Sci Rep 2019; 9: 12993.
- Sun L, Hou Y, Xiao Q, Du Y. Association of serum sodium and risk of all-cause mortality in patients with chronic kidney disease: A meta-analysis and sysematic review. Sci Rep 2017; 7: 15949.
- Kovesdy CP, Lott EH, Lu JL, et al. Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure. Circulation 2012; 125: 677-84.
- Sato N, Gheorghiade M, Kajimoto K, et al; ATTEND Investigators. Hyponatremia and in-hospital mortality in patients admitted for heart failure (from the ATTEND registry). Am J Cardiol 2013; 111: 1019-25.
- Tokgöz Akyil F, Akyil M, Çoban Ağca M, et al. Hyponatremia prolongs hospital stay and hypernatremia better predicts mortality than hyponatremia in hospitalized patients with community-acquired pneumonia. Tuberk Toraks 2019; 67: 239-47.
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- Ravioli S, Gygli R, Funk GC, Exadaktylos A, Lindner G. Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis. Eur J Intern Med 2021; 85: 63-7.
- Leong HN, Chan KP, Oon LL, et al. Clinical and laboratory findings of SARS in Singapore. Ann Acad Med Singap 2006; 35: 332-9.
- Nurlu N, Ozturk OO, Cat A, Altunok ES, Gumus A. Could some laboratory parameters predict mortality in COVID-19? Clin Lab 2021; 67.
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- Hirsch JS, Uppal NN, Sharma P, et al. Prevalence and outcomes of hyponatremia and hypernatremia in patients hospitalized with COVID-19. Nephrol Dial Transplant 2021; 36: 1135-8.
- De Carvalho H, Letellier T, Karakachoff M, et al. Hyponatremia is associated with poor outcome in COVID-19. J Nephrol 2021; 34: 991-8.
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- Berni A, Malandrino D, Parenti G, Maggi M, Poggesi L, Peri A. Hyponatremia, IL-6, and SARS-CoV-2 (COVID-19) infection: may all fit together? J Endocrinol Invest 2020; 43: 1137-9.
- Berni A, Malandrino D, Corona G, et al. Serum sodium alterations in SARS CoV-2 (COVID-19) infection: impact on patient outcome. Eur J Endocrinol 2021; 185: 137-44.
- Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020; 58: 1021-8.
- Imam Z, Odish F, Gill I, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States. J Intern Med 2020; 288: 469-76.
- Alwafi H, Naser AY, Qanash S, et al. Predictors of length of hospital stay, mortality, and outcomes among hospitalised COVID-19 patients in Saudi Arabia: A Cross-Sectional Study. J Multidiscip Healthc 2021; 14: 839-52.
- Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol 2020; 7: 671-8.
- Bannaga AS, Tabuso M, Farrugia A, et al. C-reactive protein and albumin association with mortality of hospitalised SARS-CoV-2 patients: a tertiary hospital experience. Clin Med (Lond) 2020; 20: 463-7.
Abstract
References
- Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in china: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239-42.
- COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med 2021; 47: 60-73.
- Suleyman G, Fadel RA, Malette KM, et al. Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in Metropolitan Detroit. JAMA Netw Open 2020; 3: e2012270.
- Bellan M, Patti G, Hayden E, et al. Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients. Sci Rep 2020; 10: 20731.
- Kim L, Garg S, O'Halloran A, et al. Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the US coronavirus disease 2019 (COVID-19)-associated hospitalization surveillance network (COVID-NET). Clin Infect Dis 2021; 72: 206-14.
- Fucà G, Mariani L, Lo Vullo S, et al. Weighing the prognostic role of hyponatremia in hospitalized patients with metastatic solid tumors: the HYPNOSIS study. Sci Rep 2019; 9: 12993.
- Sun L, Hou Y, Xiao Q, Du Y. Association of serum sodium and risk of all-cause mortality in patients with chronic kidney disease: A meta-analysis and sysematic review. Sci Rep 2017; 7: 15949.
- Kovesdy CP, Lott EH, Lu JL, et al. Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure. Circulation 2012; 125: 677-84.
- Sato N, Gheorghiade M, Kajimoto K, et al; ATTEND Investigators. Hyponatremia and in-hospital mortality in patients admitted for heart failure (from the ATTEND registry). Am J Cardiol 2013; 111: 1019-25.
- Tokgöz Akyil F, Akyil M, Çoban Ağca M, et al. Hyponatremia prolongs hospital stay and hypernatremia better predicts mortality than hyponatremia in hospitalized patients with community-acquired pneumonia. Tuberk Toraks 2019; 67: 239-47.
- Nair V, Niederman MS, Masani N, Fishbane S. Hyponatremia in community-acquired pneumonia. Am J Nephrol 2007; 27: 184-90.
- Ravioli S, Gygli R, Funk GC, Exadaktylos A, Lindner G. Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis. Eur J Intern Med 2021; 85: 63-7.
- Leong HN, Chan KP, Oon LL, et al. Clinical and laboratory findings of SARS in Singapore. Ann Acad Med Singap 2006; 35: 332-9.
- Nurlu N, Ozturk OO, Cat A, Altunok ES, Gumus A. Could some laboratory parameters predict mortality in COVID-19? Clin Lab 2021; 67.
- Krüger S, Ewig S, Giersdorf S, et al. CAPNETZ study group. Dysnatremia, vasopressin, atrial natriuretic peptide and mortality in patients with community-acquired pneumonia: results from the german competence network CAPNETZ. Respir Med 2014; 108: 1696-705.
- Aggarwal S, Garcia-Telles N, Aggarwal G, Lavie C, Lippi G, Henry BM. Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): Early report from the United States. Diagnosis (Berl) 2020; 7: 91-6.
- Ruiz-Sánchez JG, Núñez-Gil IJ, Cuesta M, et al. Prognostic impact of hyponatremia and hypernatremia in COVID-19 pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis. Front Endocrinol (Lausanne) 2020; 11: 599255.
- Tzoulis P, Waung JA, Bagkeris E, et al. Dysnatremia is a predictor for morbidity and mortality in hospitalized patients with COVID-19. J Clin Endocrinol Metab 2021; 106: 1637-48.
- Atila C, Sailer CO, Bassetti S, et al. Prevalence and outcome of dysnatremia in patients with COVID-19 compared to controls. Eur J Endocrinol 2021; 184: 409-18.
- Frontera JA, Valdes E, Huang J, et al. Prevalence and impact of hyponatremia in patients with coronavirus disease 2019 in New York City. Crit Care Med 2020; 48: 1211-7.
- Hirsch JS, Uppal NN, Sharma P, et al. Prevalence and outcomes of hyponatremia and hypernatremia in patients hospitalized with COVID-19. Nephrol Dial Transplant 2021; 36: 1135-8.
- De Carvalho H, Letellier T, Karakachoff M, et al. Hyponatremia is associated with poor outcome in COVID-19. J Nephrol 2021; 34: 991-8.
- Mastorakos G, Weber JS, Magiakou MA, Gunn H, Chrousos GP. Hypothalamic-pituitary-adrenal axis activation and stimulation of systemic vasopressin secretion by recombinant interleukin-6 in humans: potential implications for the syndrome of inappropriate vasopressin secretion. J Clin Endocrinol Metab 1994; 79: 934-9.
- Berni A, Malandrino D, Parenti G, Maggi M, Poggesi L, Peri A. Hyponatremia, IL-6, and SARS-CoV-2 (COVID-19) infection: may all fit together? J Endocrinol Invest 2020; 43: 1137-9.
- Berni A, Malandrino D, Corona G, et al. Serum sodium alterations in SARS CoV-2 (COVID-19) infection: impact on patient outcome. Eur J Endocrinol 2021; 185: 137-44.
- Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020; 58: 1021-8.
- Imam Z, Odish F, Gill I, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States. J Intern Med 2020; 288: 469-76.
- Alwafi H, Naser AY, Qanash S, et al. Predictors of length of hospital stay, mortality, and outcomes among hospitalised COVID-19 patients in Saudi Arabia: A Cross-Sectional Study. J Multidiscip Healthc 2021; 14: 839-52.
- Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol 2020; 7: 671-8.
- Bannaga AS, Tabuso M, Farrugia A, et al. C-reactive protein and albumin association with mortality of hospitalised SARS-CoV-2 patients: a tertiary hospital experience. Clin Med (Lond) 2020; 20: 463-7.
Details
| Primary Language | English |
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| Subjects | Health Care Administration |
| Journal Section | Original Article |
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| Publication Date | May 30, 2022 |
| Published in Issue | Year 2022 Volume: 5 Issue: 3 |
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