MANAGEMENT OF ENDOCRINE DISEASE: Dysnatraemia in COVID-19: prevalence, prognostic impact, pathophysiology, and management

Abstract

This review examines the prevalence, aetiology, pathophysiology, prognostic value and investigation of dysnatraemia in hospitalised COVID-19 patients, taking into account all relevant studies published in PubMed and Cochrane Library studies until March 2021. Hyponatraemia is commonly observed in patients with bacterial pneumonia and is an independent predictor for excess mortality and morbidity. However, it remains unknown whether this association applies to coronavirus disease-2019 (COVID-19). Several studies reported a 20-35% prevalence for hyponatraemia and 2-5% for hypernatraemia in patients admitted with COVID-19. In addition, hyponatraemia on admission was a risk factor for progression to severe disease, being associated with an increased likelihood for the need for invasive mechanical ventilation, with an odds ratio of 1.83 – 3.30. Hyponatraemia seems to be an independent risk factor for mortality, with an odds ratio of 1.40–1.50 compared to normonatraemia, while hypernatraemia is related to even worse outcomes than hyponatraemia. Furthermore, preliminary data show an inverse association between serum sodium and interleukin-6 levels, suggesting that hyponatraemia might be used as a surrogate marker for the risk of a cytokine storm and the need for treatment with interleukin antagonists. In conclusion, dysnatraemia is common and carries a poor prognosis in COVID-19 patients, indicating that it may play a future role for risk stratification and individualising therapy.

Hypernatremia increases mortality in patients admitted by COVID-19: A Retrospective longitudinal study with 1000 patients

“…We evaluated 1,000 patients hospitalized with COVID-19 and detected that hypernatremia was largely frequent, affecting 76.1% of individuals who died. Our results are consistent with those of other relevant investigations to date [7,[13][14][15]21].…”

“…Also, hypernatremia detected two days after admission and exposure to hypernatremia at any time point during hospitalization were associated with a 2.34-fold and 3.05-fold increased risk of death, respectively, compared to eunatremia. Hyponatremia at admission was linked with a 2.18-fold increase in the likelihood of needing ventilatory support [13]. These results showed the pivotal importance of sodium measures in patients hospitalized, including COVID-19 patients, mainly in ICU patients.…”

“…Interestingly, in patients hospitalized with COVID-19, was detected that admittance hyponatremia was frequent; affecting more than 20% of patients, for a total of 957 subjects, and hypernatremia was found in only 3.7%, a total of 174 subjects [8]. Another study, including 488 subjects with COVID-19, found an incidence of 24.6% of hyponatremia and 5.3% of hypernatremia [13]. Also, hypernatremia detected two days after admission and exposure to hypernatremia at any time point during hospitalization were associated with a 2.34-fold and 3.05-fold increased risk of death, respectively, compared to eunatremia.…”

“…Dysnatremia (serum sodium level > 145mmol/L or < 135mmol/L) is the most common electrolyte disturbance that has been associated with a worse prognosis for hospitalized COVID-19 patients [10][11][12][13][14][15]. It was also previously demonstrated that hospitalized patients with community-acquired pneumonia (CAP) caused by other pathogenic microorganisms presenting hyponatremia and hypovolemia have a higher risk of death [13]. Hyponatremia is also a disturbance with an incidence rate of up to 30% in hospitalized patients presenting poor prognosis in pneumonia outcome [16][17][18][19][20].…”

“…Hyponatremia is also a disturbance with an incidence rate of up to 30% in hospitalized patients presenting poor prognosis in pneumonia outcome [16][17][18][19][20]. More recently, hypernatremia during the hospitalization period was associated with a worse prognosis in COVID-19 patients [7,8,13]. The present study aimed to evaluate the association of dysnatremia with a high risk of death in COVID-19 hospitalized patients.…”