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

Abstract

The threat of COVID-19 has harried the world since early 2020. Risk of death from the infection is associated with age and pre-existing comorbidities such as diabetes, dementia, cancer, and impairment of immunological, hepatic or renal function. It still remains incompletely understood why some patients survive the disease, while others perish. Our univariate and multivariate analyses of real world data from U.S. electronic health records indicate that a priori diagnoses of fluid, pH and electrolyte imbalance are highly and independently associated with COVID-19 mortality. We propose that pre-existing homeostatic aberrations are magnified upon the loss of ACE2, which is a core component of the electrolyte management system as well as the entry point of internalizing SARS-CoV-2 viruses. Moreover, we also suggest such fragility of electrolyte homeostasis may increase the risk of plasma volume disturbances during the infection. Future interventional studies should investigate whether the risk of death can be alleviated by personalized management of the fluid and electrolyte balance of at-risk individuals before and during COVID-19.