Baseline electrolyte abnormalities would be related to poor prognosis in hospitalized coronavirus disease 2019 patients

Abstract

Electrolyte abnormalities are not uncommon in coronavirus disease 2019 (COVID-19). Several studies have suggested that various electrolyte imbalances seem to have an impact on disease prognosis. However, no study has primarily focused on the effect of baseline electrolyte abnormalities on disease outcome. In this study, we assessed the validity of the hypothesis that baseline electrolyte imbalances may be related to unfavourable outcomes in hospitalized COVID-19 patients. Design of the study was retrospective and observational. We included 408 hospitalized individuals with COVID-19 over 18 years old. Baseline levels of sodium, potassium, calcium and chloride were assessed and the effects of abnormalities in these electrolytes on requirement for intensive care unit and mechanical ventilation, hospitalization duration and treatment outcome were evaluated. Patients were clustered based on electrolyte levels and clusters were compared according to outcome variables. Frequency of other severe disease indices was compared between the clusters. Lastly, we evaluated the independent factors related to COVID-19-associated deaths with multivariate analyses. In all, 228 (55.8%) of the patients had at least one electrolyte imbalance at baseline. Hyponatraemia was the most frequent electrolyte abnormality. Patients with hyponatraemia, hypochloraemia or hypocalcaemia had, respectively, more frequent requirement for intensive care unit and mechanical ventilation, higher mortality rate and longer hospitalization. The clusters associated with electrolyte abnormalities had unfavourable outcomes. Also, Clinical and laboratory features associated with severe disease were detected more often in those clusters. Hyponatraemia was an independent factor related to death from COVID-19 (OR 10.33; 95% CI 1.62–65.62; p 0.01). Furthermore, baseline electrolyte imbalances, primarily hyponatraemia, were related to poor prognosis in COVID-19 and baseline electrolyte assessment would be beneficial for evaluating the risk of severe COVID-19.

Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country

“…This electrolyte imbalance will in turn affect the different body organ system function that could compromise the body's appropriate response to the stress caused by the disease thereby leading to more severe disease, complication and death. This is also demonstrated in other studies, where both increased and decreased levels of Na and K are found to be associated with severe disease states [19][20][21].…”

“…Electrolyte imbalance in both directions, hypo-and hyper-levels were reported for sodium, potassium and calcium levels among patients with severe disease and worse outcome, hypothesized to result from the effect of the disease on the body system or the medication side effects [19][20][21].…”

Clinical Characteristics of Hospitalized Individuals Dying with COVID-19 in Ulin Regional Hospital Banjarmasin

“…32 Some studies have shown that the majority of COVID-19 cases have electrolyte abnormalities correlated with a high risk of intensive care needs, mechanical ventilation and encephalopathy events with high mortality rates and longer treatment days. 33,34 Comparable to some other studies, most cases found that most cases had hyponatremia (55.6%). Tezcan, et al mentions that hyponatremia is the most common electrolyte abnormality compared to other electrolyte abnormalities.…”

“…In addition, hyponatremia can also be used as an independent predictor of poor prognosis in COVID-19 patients. 34 One of the clinical picture in COVID-19 is the development of lung injuries that have the potential to cause ARDS. Pneumonia and ARDS usually develop late in the course of infection between 5-10 days from the onset of clinical symptoms.…”

Hypocalcemia is associated with severe COVID-19: A systematic review and meta-analysis

“…There are 2032 patients from 7 studies included in this systematic review and meta-analysis [ [12] , [13] , [14] , [15] , [16] , [17] , [18] ] ( Fig. 1 ).…”