Disorders of sodium balance and its clinical implications in COVID-19 patients: a multicenter retrospective study

Abstract

Background The worldwide spread of SARS-CoV-2 has infected millions of people leading to over 0.3 million mortalities. The disruption of sodium homeostasis, tends to be a common occurrence in patients with COVID-19. Methods and results A total of 1,254 COVID-19 patients comprising 124 (9.9%) hyponatremic patients (under 135 mmol/L) and 30 (2.4%) hypernatremic patients (over 145 mmol/L) from three hospitals in Hubei, China, were enrolled in the study. The relationships between sodium balance disorders in COVID-19 patients, its clinical features, implications, and the underlying causes were presented. Hyponatremia patients were observed to be elderly, had more comorbidities, with severe pneumonic chest radiographic findings. They were also more likely to have a fever, nausea, higher leukocyte and neutrophils count, and a high sensitivity C-reactive protein (HS-CRP). Compared to normonatremia patients, renal insufficiency was common in both hyponatremia and hypernatremia patients. In addition, hyponatremia patients required extensive treatment with oxygen, antibiotics, and corticosteroids. The only significant differences between the hypernatremia and normonatremia patients were laboratory findings and clinical complications, and patients with hypernatremia were more likely to use traditional Chinese medicine for treatment compared to normonatremia patients. This study indicates that severity of the disease, the length of stay in the hospital of surviving patients, and mortality were higher among COVID-19 patients with sodium balance disorders. Conclusion Sodium balance disorder, particularly hyponatremia, is a common condition among hospitalized patients with COVID-19 in Hubei, China, and it is associated with a higher risk of severe illness and increased in-hospital mortality.

Hyponatremia is associated with poor outcome in COVID-19

“…Several prognostic factors have been reported in COVID-19. Although hyponatremia is common in larger cohorts of COVID-19 [18], its prognostic value has only been studied recently in American [12], Chinese [13] and Turkish [19] patients, and results showed that hyponatremia was associated with poor outcome. However, data may be modulated by genetic background, and, to our knowledge, there are currently no available data regarding a European cohort.…”

“…This condition occurred in one third of the SARS-CoV-1 infected patients and was associated with poor prognosis [10,11]. Recent studies demonstrated that hyponatremia was associated with poor outcome in COVID-19 but these studies did not include European patients [12,13] and/or did not consider plasma sodium levels at admission [13]. Also, genetic background is a risk factor for respiratory failure in COVID-19 [14], and as a consequence, prognostic factors may differ among populations.…”

COVID-19 and the pituitary

“…Other causes that can lead to the development of SIADH among patients with COVID-19 may include the use of antibiotics, corticosteroids and positive pressure ventilation (due to non-osmotic stimulation of ADH secretion as pulmonary venous baroreceptors respond to a reduction in effective blood volume) [ 74 , 86 ]. Thus, the development of SIADH may be one of the reasons of failure of positive pressure ventilation in COVID-19.…”

“…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].…”

Fluid, pH and electrolyte imbalance associated with COVID-19 mortality

“…Chen et al 2020), which will obviously average out some of the effects of opposite extremities. However, recent reports have pointed out that both hypernatremia and hyponatremia are frequently present in COVID-19 patients (Hu et al 2020). Our ndings implicate that fundamental instability of the renin-angiotensin-aldosterone system (RAAS), manifested as earlier FPEI diagnoses, and potentially as aberrations of blood pressure levels, may sensitize patients to unfavourable outcomes in COVID-19.…”