Hyponatremia: More than just an electrolyte for COVID-19 patients

Yıl 2023, Cilt: 37 Sayı: 2, 97 - 109, 06.09.2023

Serpil Müge Değer , Emre Yasar , Hasan Selçuk Özger , Pınar Aysert Yıldız , Ulver Derici

https://doi.org/10.18614/deutip.1218114

Öz

AIM: Hyponatremia is the most common electrolyte disturbance among infections, especially with pneumonia. Here, we aimed to analyze the presence of hyponatremia among COVID-19 patients along with its relation to mortality.
MATERIALS and METHODS: Patients were divided into two groups COVID-19 negative and positive and also another group with pneumonia and without pneumonia for covid-19 PCR positive patients. The association between hyponatremia and in-hospital mortality from any cause was evaluated with univariate and multivariate cox regression model.
RESULTS: A total of 636 patients, a mean age of 50± 18 years, 48 % of the female with a median duration of hospitalization of 5.5 (IQR, 2,11) days were included. Of those 553 (%87) were detected COVID-19 PCR positive and 298 (47%) of those with pneumonia. The median serum sodium concentration was lower in COVID-19 PCR positive patients [134 (IQR, 130,137) mEq/L] compared to negatives [139 (IQR, 136, 140) mEq/L] (p<0.001). The median serum sodium levels were significantly lower in patients with pneumonia [136 (IQR, 133.138) mEq/L] than without pneumonia [139 (IQR, 137, 145) mEq/L] (p<0.001). All deaths occurred in patients with pneumonia [(n=40 (13.4 %)]. Patients with hyponatremia had increased mortality on unadjusted (OR, 3.85, 95%CI: 1.73, 8.53, P<0.001) and adjusted [OR, 3.58, 95%CI: 1.58, 8.1, P=0.002] in Cox proportional hazard models
CONCLUSION: Hyponatremia at admission is prevalent and an independent risk factor for in-hospital mortality among COVID-19 patients particularly those with pneumonia. It might be an important laboratory clue for both the diagnosis and survive of these patients.

Anahtar Kelimeler

COVID-19, hyponatremia, pneumonia, mortality

Hiponatremi:COVID-19 hastaları için elektrolitden daha fazlası

Öz

AMAÇ: Hiponatremi özellikle pnömonisi olan hasta grubunda sık rastlanan bir elektrolit anomalisidir. Biz bu çalışmada, COVID-19 pozitif hasta grubunda hiponatremi sıklığı ile mortalite arasındaki ilişkiyi değerlendirmeyi hedefledik.
METOD: Hastalar COVID-19 PCR pozitif, negatif ve COVID-19 PCR pozitif hastalar ise kendi içinde pnömoni olan ve olmayanlar olarak gruplara ayrıldı. Hiponatremi ve mortalite arasındaki ilişki tek değişkenli ve çok değişkenli COX regresyon analizi ile incelendi.
SONUÇLAR: Ortalama yaşı 50± 18 yıl olan 636 hasta çalışmaya dahil edildi. Hastaların %, 48'i kadın ve ortanca hastanede yatış süreleri ise 5.5 (IQR, 2,11) gündü. Hastaların 553 (%87) 'ünde COVID-19 PCR pozitif, ve pozitif hastaların 298'inde (%47) pnömoni saptandı. Ortanca serum sodyum konsantrasyonu COVID-19 PCR pozitif [134 (IQR, 130,137) mEq/L] hastalarda, negatif [139 (IQR, 136, 140) mEq/L] (p<0.001) olan hastalara göre düşük saptandı. COVID-19 PCR pozitif hasta grubu içinde pnömoni hasta grubunda [136 (IQR, 133.138) mEq/L]serum sodyum konsantrasyonu pnömoni olmayan[139 (IQR, 137, 145) mEq/L] (p<0.001) gruba göre istatistiksel olarak anlamlı düzeyde düşük saptandı Tüm ölümler pnömoni ile başvuran hasta grubunda izlendi [(n=40 (13.4 %)]. Hiponatremi hem tek değişkenli (OR, 3.85, 95%CI: 1.73, 8.53, P<0.001) hem de çok değişkenli [OR, 3.58, 95%CI: 1.58, 8.1, P=0.002] Cox regresyon modelinde mortalite için bağımsız bir risk faktörü olduğu görüldü.
TARTIŞMA: Hastaneye başvuran COVID-19 PCR pozitif hastalarda özellikle pnömoni saptanan grupta hiponatremi sık görülmekte ve mortalite için bağımsız bir risk faktörü olarak izlenmektedir. Bu hasta grubunda prognozun belirlenmesi açısından hiponatremi önemli bir laboratuvar parametresi olarak görev yapabilir.

Anahtar Kelimeler

COVID-19, Hiponatremi, pnömoni, mortalite

Kaynakça

• 1. Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med. 2006;119(7 Suppl 1):S30-5.
• 2. Dineen R, Thompson CJ, Sherlock M. Hyponatraemia - presentations and management. Clin Med (Lond). 2017;17(3):263-9.
• 3. Krolicka AL, Kruczkowska A, Krajewska M, Kusztal MA. Hyponatremia in Infectious Diseases-A Literature Review. Int J Environ Res Public Health. 2020;17(15).
• 4. Karki L, Thapa B, Sah MK. Hyponatremia in Patients with Community Acquired Pneumonia. JNMA J Nepal Med Assoc. 2016;54(202):67-71.
• 5. Wu Y, Hou B, Liu J, Chen Y, Zhong P. Risk Factors Associated With Long-Term Hospitalization in Patients With COVID-19: A Single-Centered, Retrospective Study. Front Med (Lausanne). 2020;7:315.
• 6. 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(2):91-6.
• 7. Yousaf Z, Al-Shokri SD, Al-Soub H, Mohamed MFH. COVID-19-associated SIADH: a clue in the times of pandemic! Am J Physiol Endocrinol Metab. 2020;318(6):E882-E5.
• 8. Werion A, Belkhir L, Perrot M, Schmit G, Aydin S, Chen Z, et al. SARS-CoV-2 causes a specific dysfunction of the kidney proximal tubule. Kidney Int. 2020;98(5):1296-307.
• 9. Huang D, Lian X, Song F, Ma H, Lian Z, Liang Y, et al. Clinical features of severe patients infected with 2019 novel coronavirus: a systematic review and meta-analysis. Ann Transl Med. 2020;8(9):576.
• 10. Ruiz-Sanchez JG, Nunez-Gil IJ, Cuesta M, Rubio MA, Maroun-Eid C, Arroyo-Espliguero R, 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.
• 11. Hu W, Lv X, Li C, Xu Y, Qi Y, Zhang Z, et al. Disorders of sodium balance and its clinical implications in COVID-19 patients: a multicenter retrospective study. Intern Emerg Med. 2021;16(4):853-62.
• 12. Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170(3):G1-47.
• 13. Post A, Dullaart RPF, Bakker SJL. Sodium status and kidney involvement during COVID-19 infection. Virus Res. 2020;286:198034.
• 14. Uribarri A, Nunez-Gil IJ, Aparisi A, Becerra-Munoz VM, Feltes G, Trabattoni D, et al. Impact of renal function on admission in COVID-19 patients: an analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) Registry. J Nephrol. 2020;33(4):737-45.
• 15. Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J, Tesoriero J, et al. Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA. 2020;323(24):2493-502.
• 16. De Carvalho H, Letellier T, Karakachoff M, Desvaux G, Caillon H, Papuchon E, et al. Hyponatremia is associated with poor outcome in COVID-19. Journal of Nephrology. 2021;34(4):991-8.
• 17. 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(8):1137-9.
• 18. Cuesta M, Slattery D, Goulden EL, Gupta S, Tatro E, Sherlock M, et al. Hyponatraemia in patients with community-acquired pneumonia; prevalence and aetiology, and natural history of SIAD. Clin Endocrinol (Oxf). 2019;90(5):744-52.
• 19. Tokgoz Akyil F, Akyil M, Coban Agca M, Gungor A, Ozanturk E, Sogut G, et al. Hyponatremia prolongs hospital stay and hypernatremia better predicts mortality than hyponatremia in hospitalized patients with community-acquired pneumonia. Tuberk Toraks. 2019;67(4):239-47.
• 20. Emine Emektar FNK, Filiz Koc, Seda Dagar, Huseyin Uzunosmanoglu, Seref Kerem Corbacioglu. Evaluation of Hyponatremia and Predictors of Hyponatremia in Patients Hospitalized with Th COVID-19. Euroasian J Emerg Med. 2021;20(3):183-9.