Hypokalemia and Its Correlates Among Nigerian SARS-CoV-2 Infected Patients

Abstract

Background: Disorders of electrolytes balance, especially that of potassium, have frequently been documented among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, most of these reports have been documented among the western populations. Hence, this current study was aimed to evaluate the pattern of derangement in potassium balance and its correlation to other clinical and laboratory variables among Nigerians. Methods: Archived data of all eligible adult patients, who were managed at the Eleme treatment center in Port Harcourt, Nigeria following a positive real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection, were enrolled for this study. All relevant data of enrolled subjects were retrieved from the archived case notes, medical review charts, nurses' charts, and laboratory-related records at initial presentation before any form of medical treatment by trained research assistants using well-structured data extraction forms. The collected data was analyzed using descriptive and comparative statistics. Results: Hypokalemia was recorded in 323 (62.8%) subjects out of a total of 515 eligible subjects. Mild, moderate, and severe hypokalemia was recorded among 32 (9.9%), 219 (67.9%), and 72 (22.2%) subjects, respectively. The subjects with severe hypokalemic status were mostly males and also of older age and had significantly higher systolic blood pressure, CRP, D-dimer, neutrophil count, and higher proportions of those with severe SARS-CoV-2 infection but lower albumin levels, lymphocyte and platelet counts compared to those with mild and moderate hypokalemic status (p<0.05). Inverse relationships were established between plasma potassium status and systolic blood pressure, sodium, C-reactive protein, D-dimer, and neutrophil count. While a significant positive relationship was observed between plasma potassium status and plasma albumin, lymphocyte counts, platelet counts, and oxygen saturation among the hypokalemic subjects (p<0.05). Compare to mild and moderate hypokalemic status, severe hypokalemic status was associated with severe SARS-CoV-2 infection (OR: 5.671; (95%CI: 4.467-7.365); p<0.001) and unfavorable clinical outcomes (OR: 7.863; (95%CI: 6.502-9.342); p<0.001) among the hypokalemic subjects. Conclusion: The present study findings suggest a high frequency of hypokalemia among subjects with the SARS-CoV-2 infection who are mostly males and of older age. The observed hypokalemia, especially the severe variant, was found in association with the severe infection and unfavorable clinical outcome. These findings should be considered during the management of SARS-CoV-2 infection. However, further studies are recommended to verify the conclusions of the present study.

Sodium Status and Its Correlation with Indices of Pulmonary Dysfunction in COVID-19 Patients

“…Data from recent studies indicate that derangement in sodium status tends to correlate significantly with the extent of SARS-CoV-2-induced pulmonary dysfunctions [14]- [16]. However, most of these previous studies were mostly reported among Caucasians [7], [8]. Racial background is a major determinant of SARS-CoV-2 pathophysiology [15], [17], consequently, conclusions from these previous studies may not reflect populations of Negroid race.…”

“…Among the biochemical abnormalities frequently reported is the derangement in water-electrolyte balance especially those of sodium disorders which have been reported in association with adverse outcomes of the disease [7]- [13]. Data from recent studies indicate that derangement in sodium status tends to correlate significantly with the extent of SARS-CoV-2-induced pulmonary dysfunctions [14]- [16].…”