Hyponatremia in COVID‐19 patients: Experience from Bangladesh

Islam, Md. Khairul; Hasan, Pratyay; Sharif, Md. Mohiuddin; Khan, Tazdin Delwar; Ratul, Rifat Hossain; Hossain, Fahima; Molla, Md. Maruf Ahmed

doi:10.1002/hsr2.565

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…A similar rate (45.8%) was also documented in the United States in a prospectively-designed study [10]. Consistent with our findings, authors of another recent similar study, which was conducted in Bangladesh, observed that hyponatremia was associated with moderate and severe COVID-19 [11]. Data from recent studies [8] [10], indicate that COVID-19 patients with hyponatremia at presentation had a higher burden of inflammatory markers, higher respiratory rate, lowered oxygen saturation levels, higher rate of oxygen support, and higher consolidation on CT-scan of the chest compared to normonatremic patients.…”

Section: B Relationship With Existing Literaturesupporting

confidence: 91%

“…Plasma sodium status was categorized into three groups according to sodium level as normonatremia (135-145 mmol/L), hyponatremia (<135 mmol/L), and hypernatremia (>145 mmol/L) [9]. Hyponatremia was further graded as mild (130-134 mmol/L), moderate (121-129 mmol/L), and severe (<120 mmol/L) [11]. Hypernatremia was also graded as mild (146-150 mmol/L), moderate (151-160 mmol/L), and severe (>160 mmol/L) [20].…”

Section: ) Definition Of Plasma Sodium Categoriesmentioning

confidence: 99%

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Sodium Status and Its Correlation with Indices of Pulmonary Dysfunction in COVID-19 Patients

Otukunefor

Amadi

Lawson

et al. 2023

EJMED

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Background: COVID-19-induced hyponatremia is reportedly associated with pulmonary dysfunction, but mostly among Caucasians. Hence, the current study evaluated sodium status and its correlation with indices of pulmonary dysfunctions among Nigerians of Negroid race. Methods: This was a retrospectively-designed observational study. Data, all obtained at presentation, were acquired from medical records of 480 RT-PCR-confirmed COVID-19 patients managed at a COVID-19-designated treatment facility in Port Harcourt, Southern Nigeria. Analysis of acquired data was done by COVID-19 clinical grades and sodium status using descriptive and inferential statistics. Results: At presentation, hyponatremia and hypernatremia were observed in 47.7% and 1.0% of the entire studied cohorts (n=480), respectively. Both disorders (hyponatremia/hypernatremia) were mostly observed among the moderate, severe, and critical cases. Most hyponatremic cases (n=154;67.2%) and the entire hypernatremic cases (n=5;100%) were of mild grades. Hyponatremics had higher proportions of fever, breathlessness, confusion, and a higher burden of inflammatory markers which increased with worsening hyponatremic grade. Etiologically, hyponatremia was mostly associated with the syndrome of inappropriate anti-diuretic hormone secretion (SIADH) (n=132;56.7%). Among the hyponatremics, an inverse correlation existed between sodium and respiratory rate (RR), while a correlation existed between sodium and oxygen saturation (SpO2). Compared to mild hyponatremics, the moderate/severe hyponatremics had a greater risk of having RR>30 and SpO2 <95%. Conclusion: Hyponatremia, mostly of mild grade, was common among the studied COVID-19 patients and was associated with indices of pulmonary dysfunctions, including disease severity, inflammatory markers, and SIADH. Hence, hyponatremia should be utilized to triage COVID-19 patients at presentation. However, further studies are recommended to verify these findings.

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Section: B Relationship With Existing Literaturesupporting

confidence: 91%

Section: ) Definition Of Plasma Sodium Categoriesmentioning

confidence: 99%

Sodium Status and Its Correlation with Indices of Pulmonary Dysfunction in COVID-19 Patients

Otukunefor

Amadi

Lawson

et al. 2023

EJMED

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“…According to disease severity, the prevalence of disease, hyponatremia has been reported to range from 9.9 to 63.6% in COVID-19 patients. [24][25][26] The water and sodium balance is regulated by water intake pathways (osmoregulation) and antidiuretic hormone, renin-angiotensin-aldosterone system, and natriuretic hormone pathway (volume regulation). The clinical appearance of diminished regulation includes hypernatremia (too little water), hyponatremia (too much water), volume expansion (too much sodium), volume depletion (too little sodium), and polyuria.…”

Section: Discussionmentioning

confidence: 99%

Baseline electrolyte disorders predict disease severity and mortality in patients with COVID-19

Hoca

Berktaş²

2022

Medicine

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Distinguishing critical laboratory biomarkers for disease severity at the time of hospital presentation is important for early identification of patients who are most likely to have poor outcomes and effective use of health resources. This study aimed to evaluate whether electrolyte imbalances on hospital admission predict severe disease and mortality in patients with coronavirus disease 2019 (COVID-19). We retrospectively collected data on the blood electrolyte concentrations of 286 COVID-19 patients at admission. The correlations between electrolyte imbalances, inflammation, and thrombosis markers in COVID-19 patients were also evaluated. We assessed the predictive performance of baseline blood electrolyte concentrations for severe disease and death using receiver operating characteristic curve analysis and multivariate logistic regression methods. Abnormalities in serum sodium, calcium, and potassium levels at admission were found at 20.6%, 14%, and 4.2%, respectively in this study. In the receiver operating characteristic curve analyses, hypocalcemia and hyponatremia effectively predicted disease progression to hospitalization (area under the curve 0.82, P < .001 and 0.81, P < .001, respectively) and 30-day mortality (area under the curve 0.85, P < .001 and 0.91, P < .001, respectively). In the multivariate logistic regression analysis, baseline hypocalcemia was identified as an independent risk factor associated with the risk of hospitalization ( β = 2.019, P = .01; odds ratio: 7.53). Baseline hypocalcemia and hyponatremia effectively predicted disease progression toward hospitalization and 30-day mortality in patients with COVID-19. Clinicians should closely follow up or reevaluate COVID-19 patients with baseline electrolyte disorders.

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“…It occurs in approximately 20-64% of patients with COVID-19. [34][35][36][37][38][39] Previous studies have indicated increased odds of poor outcomes among COVID-19 patients with hyponatremia, and most of them regarded hyponatremia as a bystander factor rather than a risk factor. 38 However, our study found that baseline hyponatremia before infection was associated with worse outcomes, suggesting that hyponatremia may also be a contributor to poor outcomes, at least in the PD population.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and outcomes in Chinese peritoneal dialysis patients

Liao,

Zhou,

et al. 2024

Perit Dial Int

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Background: Reports on COVID-19 in peritoneal dialysis (PD) patients are scarce in China. This study aimed to describe the characteristics and outcomes of PD patients with COVID-19 after China abandoned the ‘zero-COVID’ policy. Methods: This single-centre retrospective study included patients receiving PD who underwent testing for COVID-19 infections between 7 December 2022 and 7 January 2023. Outcomes of interest included factors associated with positive COVID-19 testing result and clinical outcomes including COVID-19-related hospitalisation and severe COVID-19, which were analysed using logistic regression analyses. Results: A total of 349 PD patients (male 53.6%, age 49 ± 13 years old) were included, and 235 patients (67.3%) were infected. There were no significant differences between COVID-19 and non-COVID-19 patients other than higher proportion of vaccinated patients and slow transporters in the patients who tested positive for COVID-19 (44.7% vs. 28.1%, p = 0.003; 8.7% vs. 1.8%, p = 0.03, respectively). Multivariate analysis showed COVID-19 was associated with vaccination (odds ratio (OR): 1.71, 95% confidence interval (CI): 1.02–2.86) and slow transport type (compared with average transport type, OR: 4.52, 95% CI: 1.01–20.21). Among the patients with infection, 38 (16.2%) patients were hospitalised, 18 (7.7%) patients had severe disease and 9 (3.8%) patients died. In multivariate logistic analysis, both age (OR: 1.04, 95% CI: 1.01–1.07; OR: 1.06, 95% CI: 1.02–1.11) and hyponatremia (OR: 5.44, 95% CI: 1.63–18.13; OR: 6.50, 95% CI: 1.77–23.85) were independent risk factors for COVID-19-related hospitalisation and severe disease. Conclusions: Although vaccinated patients were more likely to have tested positive for COVID-19 infection, they appeared to have less severe infection and less need for hospitalisation. Patients who were older with a history of hyponatremia were more likely to experience adverse outcomes from COVID-19.

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Hyponatremia in COVID‐19 patients: Experience from Bangladesh

Cited by 7 publications

References 22 publications

Sodium Status and Its Correlation with Indices of Pulmonary Dysfunction in COVID-19 Patients

Sodium Status and Its Correlation with Indices of Pulmonary Dysfunction in COVID-19 Patients

Baseline electrolyte disorders predict disease severity and mortality in patients with COVID-19

COVID-19 and outcomes in Chinese peritoneal dialysis patients

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