Prognostic Value of Dysnatremia in COVID-19 Disease

Abstract

Objective: The infection of Corona 2019 (COVID-19) had first diagnosed in December 2019 and evolved into a worldwide pandemic in March 2020. In Turkey first diagnose was announced in March 2020. Low costed and easily accessible laboratory parameters needed for predicting the prognosis of this disease as its outcome pattern vary greatly from patient to patient. There is promising data on predicting the outcomes with disnatremic results. Methods: In this study we retrospectively investigated all adults with the diagnosis of COVID-19 who attended to Turkan Ozilhan Hospital over a 3 months period. We evaluated the relation of dysnatremia (hyponatremia as <135 mmol/L or hypernatremia as >145 mmol/L) for need of intensive care unit (ICU) treatment, need of intubation for mechanic ventilatory support and inpatient mortality. Results: one thousand seventy tree patients with COVID-19 [53..9% males (793 patients) and 46.1% females (680 patients), were investigated for this study. Their median age was 53.9 years ranging betweent 19-94. The dysnatremic groups had significantly higher rates of need for ICU and intubation The need for ICU was 89 (21.5%) patients in normonatremic group but 38 (76%) patients in hypernatremic and 71 (64%) in hyponatremic patients (p<0.01 for each of them). The mortality rate was 5% in normonatremic patients but 50% in hypernatremic and 28% in hyponatremic patients (p<0.01 for each of them). Conclusion: In this study we aimed to draw attention to the importance of abnormal sodium levels as a predictive marker in COVID-19. In small town hospitals the physicians should be aware of the risks of disnatremic patients with COVID-19 and take precautions while treating them.

Prognostic Impact of Dysnatremia in COVID-19 Pneumonia: Risk Stratification of Hospitalized Patients

“…In accordance with some previous studies, 7,10,11,13 signi cantly increased number of non-survivors amongst hypernatremic COVID-19 positive participants (44/106) compared to that of hyponatremic (10/47) and eunatremic (19/238) participants suggested that outcome of hypernatremia is harsher than the hyponatremia. The total physiological alterations resulting from hypernatremia leading to negative inotropic effect, increased hyperventilation, altered glucose metabolism, brain cell shrinkage and vascular rupture may be the contributory factor of high mortality in hypernatremia.…”

“…32 We employed both the severity scores but due to non-availability of all the required parameters we could calculate the SOFA score of only 28 positive patients, associated with severe illness and increased fatality rate. [4][5][6][7][8][9]13,20,33 Comparable to our ndings, few studies have also been reported testifying hypernatremia to be a common extra-pulmonary impediment in COVID-19 patients associated with adverse outcome, increased length of ICU stay and even increase mortality. 1,10,34 Angiotensin-converting enzyme 2 (ACE2), a counter regulator of reninangiotensin-aldosterone system (RAAS), is considered as the speci c functional receptor for invasion of the SARS-CoV-2 into the human body leading to suboptimal level of this enzyme in infected individuals.…”

“…the dysregulation of the immune system may lead to the development of hyponatremia in patients with COVID-19 pneumonia. 4,13 Altogether 37.9% (145/383) con rmed some form of dysnatremia (hyponatremia, hypernatremia, or both) compared to only 20% (18/90) from the control group during their hospital stay and the difference was statistically signi cant (p = 0.02). It was observed that 2.1% (08/383) of all analyzed COVID-19 participants developed both hyper and hyponatremia during their hospital stay without any relationship with intravenous uids administration.…”

“…7,10 Incidents of occurrence of treatment resistant hypernatremia were also reported which may be resulted from scrupulous use of steroids and diuretics to treat the COVID-19 patients. 7,11 Severe dysnatremia is associated with poor prognosis and worse outcome 4,6,7,[12][13][14][15] and therefore, this association of dysnatremia with viral infection and sepsis needs more attention to unravel its relation with poor prognosis in patients admitted with COVID-19.…”