Dysnatremia is a Predictor for Morbidity and Mortality in Hospitalized Patients with COVID-19

Abstract

Background Dysnatremia is an independent predictor of mortality in patients with bacterial pneumonia. There is paucity of data about the incidence and prognostic impact of abnormal sodium concentration in patients with coronavirus disease 19 (COVID-19). Methods This retrospective longitudinal cohort study, including all adult patients who presented with COVID-19 to two hospitals in London over an 8-week period, evaluated the association of dysnatremia (serum sodium < 135 or > 145 mmol/L, hyponatremia and hypernatremia, respectively) at several timepoints with inpatient mortality, need for advanced ventilatory support and acute kidney injury (AKI). Results The study included 488 patients (median age 68 years). At presentation, 24.6% of patients were hyponatremic, mainly due to hypovolemia, and 5.3% hypernatremic. Hypernatremia two days after admission and exposure to hypernatremia at any timepoint during hospitalization were associated with a 2.34-fold (95% CI 1.08 – 5.05, p=0.0014) and 3.05-fold (95% CI 1.69 – 5.49, p<0.0001), respectively, increased risk of death compared to normonatremia. Hyponatremia at admission was linked with a 2.18-fold increase in the likelihood of needing ventilatory support (95% CI 1.34-3.45, p= 0.0011). Hyponatremia was not a risk factor for in-hospital mortality, except for the subgroup of hypovolemic hyponatremia. Sodium values were not associated with the risk for AKI and length of hospital stay. Conclusion Abnormal sodium levels during hospitalization are risk factors for poor prognosis, with hypernatremia and hyponatremia being associated with a greater risk of death and respiratory failure, respectively. Serum sodium values could be used for risk stratification in patients with COVID-19.

COVID-19 outpatients and surviving inpatients exhibit comparable blood test results that are distinct from non-surviving inpatients

“…In addition to CRP and HGB, calcium, potassium, sodium, WBC, neutrophil, lymphocyte cell count and Vitamin-D are extensively discussed in the literature (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). All of these factors except Vitamin D and potassium show significant differences between non-surviving and surviving patients in Table 3 and are discussed in the literature, which confirm our findings and indicate dysregulation in COVID-19 patients.…”

COVID-19 and the pituitary

“…Hyponatremia at admission was so far independently associated with male sex, old age [73], presence of several comorbidities and diagnosis of severe pneumonia on chest X-ray [74]. Moreover, poorer clinical outcomes and higher mortality were reported in COVID-19 patients with hyponatremia [75].…”

ENDOCRINOLOGY IN THE TIME OF COVID-19-2021 UPDATES: The management of diabetes insipidus and hyponatraemia

“…Recent literature suggests that hyponatraemia in COVID-19 patients is at least as common as in other pneumonia cases. Berni et al showed a prevalence of hyponatremia of 22.9%, which is in the range of most other literature showing a prevalence of around 20-30% [5][6][7]9 . An even higher prevalence of 40% has been shown in a large study in 10'000 patients across 13 hospitals in a New York health system 4 .…”

“…Initial data suggested that hypernatraemia, in contrast to other critically ill patients, is not a risk factor for severe mortality in COVID-19 25 . More recent data, however, show that hypernatraemia is associated with adverse outcomes and mortality, similar to other critically ill patients [4][5][6][7] .…”

“…Especially patients with central diabetes insipidus (DI) or pre-existing hyponatraemia may be at risk of more severe, life threatening dysnatraemia. Regardless of pre-existing endocrine conditions, hyponatraemia is common in patients hospitalized with COVID-19 [2][3][4][5][6][7][8][9] and is associated with disease severity and mortality. This article is intended to advise how endocrinologists can still optimally care for ambulatory patients with central DI and hyponatraemia, where regular physical consultations and biochemical assessments are not possible.…”