Association of hypernatremia with outcomes of COVID-19 patients: A systematic review and meta-analysis

Shrestha, Abhigan Babu; Sapkota, Unnat Hamal; Shrestha, Sajina; Aryal, Manjil; Chand, Swati; Thapa, Sangharsha; Chowdhury, Faisal Mahbub; Abdullah, Shahrum; Shrestha, Shumneva; Shah, Sangam; Jaiswal, Vikash

doi:10.1097/md.0000000000032535

Cited by 11 publications

(11 citation statements)

References 58 publications

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“…However, their study failed to report the outcomes of patients who received RRT (28). Khalili They noted that hypernatremia was also associated with ICU admission and mortality in these patients (33). Our study confirms both of these findings, reporting a significant association between incidence of AKI and these electrolyte imbalances, hypernatremia, and hyperkalemia.…”

Section: Discussionsupporting

confidence: 82%

Outcomes, Risk Factors, and Incidence of Acute Kidney Injury in Hospitalized COVID-19 Patients

2023

ircmj

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Background: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) is the virus causing Coronavirus Disease 2019 (COVID-19). Apart from respiratory disease, this virus can affect different organs. Objectives: Therefore, multiple mechanisms have been hypothesized for Acute Kidney Injury (AKI) in COVID-19. In this study, we evaluate the incidence and prognosis of AKI in COVID-19 patients. Methods: This retrospective cohort study assessed 397 COVID-19 patients hospitalized between April 1, 2020, and September 30, 2021. Patients with a sudden rise of serum creatinine level, more than 0.3 mg/dl in two days or more than 50% of the initial level in one week, were diagnosed with AKI. Demographic, laboratory, and clinical features were compared in AKI patients with patients without AKI. Results: A total of 397 patients with a mean age ± standard deviation of 55.42 ± 15.26 years were included in the study. According to diagnostic criteria, 48 (12.1%) patients developed AKI. Old age, a history of hypertension, and chronic renal failure were suggested as risk factors for AKI. High levels of C-Reactive Protein, Erythrocyte Sedimentation Rate, Lactate Dehydrogenase, D-dimer, and serum phosphorus upon arrival were also associated with an increased risk of AKI. In addition, the incidence of hypernatremia and hyperkalemia increased mortality in patients with AKI. Conclusion: The incidence of AKI in admitted COVID-19 patients affects the duration of hospitalization, the chance of ICU admission, and mortality. It is important to limit the use of nephrotoxic drugs and to maintain water-electrolyte balance to prevent the incidence of AKI and improve the outcome.

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Section: Discussionsupporting

confidence: 82%

Outcomes, Risk Factors, and Incidence of Acute Kidney Injury in Hospitalized COVID-19 Patients

2023

ircmj

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“…This difference in the incidence of hypernatremia could be attributed to the threshold used to define hypernatremia (145 mEq/L to >147 mEq/L) as well as the timing of sodium measurements. 17 The increased development of hypernatremia in patients with COVID-19 could be attributed to low water intake owing to loss of taste, anorexia, nausea, or other gastrointestinal complaints.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Frequency of dysnatremia in patients admitted with COVID-19 infection and its prognostic implication

Gul Khan,

Sattar,

Yaqoob

et al. 2023

J Int Med Res

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Objective We aimed to investigate the frequency of dysnatremia among patients admitted with COVID-19 infection and its association with inpatient mortality. Methods This retrospective longitudinal study was conducted for 12 weeks. Serum sodium levels were recorded at admission, during the hospital stay, and within 48 hours of discharge or death. Logistic regression was used to determine the predictors of mortality. Results This study included 574 patients (69.7% men, age 55.6 ± 14.4 years). On admission, mean sodium was 135.9 ± 6.4 mEq/L; 39% had hyponatremia and 4.7% had hypernatremia. During admission, hypernatremia increased to 18.8%; maximum sodium in patients who survived was 140.6 ± 5.0 mEq/L versus 151.0 ± 9.9 mEq/L in those who died. The final sodium was 145.4 ± 9.4 mEq/L in patients who died versus 137.7 ± 3.7 mEq/L in those who survived (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.13–1.32). Other predictors of mortality included ischemic heart disease (OR: 3.65, 95% CI: 1.39–9.61), acute kidney injury (OR: 6.07, 95% CI: 2.39–15.42), invasive ventilation (OR: 28.4, 95% CI: 11.14–72.40), and length of stay (OR: 0.91, 95% CI: 0.86–0.97). Conclusion Hypernatremia was frequently observed in patients who were critically ill and died and may be considered a predictor of mortality in COVID-19 infection.

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“…So, the identification of reliable predictors of clinical deterioration is a major concern for clinicians to stratify the risk for each patient and focus the treatment efforts on those with a worse expected clinical outcome. 6 Various parameters, such as C- reactive protein (CRP), procalcitonin, d-dimer, lactate dehydrogenase, 7 interleukin 6 (IL-6), lymphopenia, hypernatremia 8 and radiological characteristics have been used in clinical practice to assess the severity of COVID-19 infection. Among these Krebs von den Lungen-6 (KL-6) factor has also been established as a possible severity marker and prognostic tool by various articles.…”

Section: Introductionmentioning

confidence: 99%

Serum Krebs von den Lungen-6 for Predicting the Severity of COVID-19: A Systematic Review, Meta-Analysis, and Trial Sequence Analysis

Shrestha

Pokharel

Singh

et al. 2023

Clin Med Insights Circ Respir Pulm Med

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OBJECTIVE This systematic review and meta-analysis aimed to find the association between serum Krebs von den Lungen-6 (KL-6) and the severity of Coronavirus disease 2019 (COVID-19) infection. DATA SOURCES Databases of Embase, PubMed, Web of Science, Science Direct, and Google Scholar were searched for studies reporting KL-6 levels in COVID-19 patients, published between January 2020 and September 30 2022. DATA SYNTHESIS For comparison between the groups, standard mean difference (SMD) and 95% confidence intervals (CI) were computed as the effect sizes. Sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were measured to assess the diagnostic power of KL-6. In addition, the summary receiver operating characteristics curve (sROC) was constructed to summarize the true positive (TP), and false positive (FP) rates. To validate the findings of meta-analysis, Trial Sequential Analysis (TSA) was conducted. RESULTS Altogether 497 severe COVID-19 patients and 934 non-severe (mild to moderate) COVID-19 patients were included. Pooling of 12 studies indicated that the serum KL-6 level had significant association with severity of COVID-19 infection: standard mean difference = 1.18 (95% CI: 0.93-1.43), p = 0.01; I2: 58.56%]. Pooled diagnostic parameters calculated from eight studies were: sensitivity 0.53 (95% CI: 0.47-0.59); specificity 0.90 (95% CI: 0.88-0.93); positive likelihood ratio 4.80 (95% CI: 3.53-6.53); negative likelihood ratio 0.46 (95% CI: 0.32-0.68); and area under curve: 0.8841. Additionally, TSA verified the adequacy of sample size and robustness of the meta-analysis. CONCLUSION Serum KL-6 level has a moderate degree of correlation with the severity of COVID-19 infection but has low sensitivity. So, it is not recommended as a screening test for severe COVID-19 infection.

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Association of hypernatremia with outcomes of COVID-19 patients: A systematic review and meta-analysis

Cited by 11 publications

References 58 publications

Outcomes, Risk Factors, and Incidence of Acute Kidney Injury in Hospitalized COVID-19 Patients

Outcomes, Risk Factors, and Incidence of Acute Kidney Injury in Hospitalized COVID-19 Patients

Frequency of dysnatremia in patients admitted with COVID-19 infection and its prognostic implication

Serum Krebs von den Lungen-6 for Predicting the Severity of COVID-19: A Systematic Review, Meta-Analysis, and Trial Sequence Analysis

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