Impacto de la corrección temprana de la hiponatremia en el pronóstico de la infección del síndrome respiratorio agudo grave del coronavirus 2 (SARS-CoV-2)

Flor, J. C. De la; Gómez-Berrocal, Ana; Marschall, Alexander; Valga, Francisco; Liñares, Tania; Albarracín, Cristina; Ruiz, Elisa; Gallegos, Gioconda; Gómez, Alberto; Santos, Andrea de Los; Rodeles, Miguel

doi:10.1016/j.medcli.2021.07.006

Cited by 3 publications

(2 citation statements)

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“…We detected a mortality rate of 21.5% in the entire group of COVID-19 patients. Our finding is within the range that has been described by other authors, from 20 to 30·% ( 6 , 8 – 13 , 49 , 51 , 60 ). Although the presence of hyponatremia is clearly related with reduced survival ( 6 , 9 – 13 , 60 ), risk factors for mortality in hospitalized COVID-19 patients with hyponatremia have been sought in only in two studies to date.…”

Section: Discussionsupporting

confidence: 91%

“…However, none of these studies evaluated the evolution of patients as a function of treatment for hyponatremia. In fact, only one study, to our knowledge, described the impact of the correction of hyponatremia on prognosis of COVID-19 patients, demonstrating that a SNa improvement at 72-96 hours after admission was associated with a higher survival rate ( 51 ). Neither volemia nor type of therapy were assessed.…”

Section: Discussionmentioning

confidence: 99%

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Inappropriate therapy of euvolemic hyponatremia, the most frequent type of hyponatremia in SARS-CoV-2 infection, is associated with increased mortality in COVID-19 patients

Pazos-Guerra,

Ruiz-Sánchez,

Pérez-Candel

et al. 2023

Front. Endocrinol.

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IntroductionAdmission hyponatremia, frequent in patients hospitalized for COVID-19, has been associated with increased mortality. However, although euvolemic hyponatremia secondary to the Syndrome of Inappropriate Antidiuresis (SIAD) is the single most common cause of hyponatremia in community-acquired pneumonia (CAP), a thorough and rigorous assessment of the volemia of hyponatremic COVID-19 subjects has yet to be described. We sought to identify factors contributing to mortality and hospital length-of-stay (LOS) in hospitalized COVID-19 patients admitted with hyponatremia, taking volemia into account.MethodRetrospective study of 247 patients admitted with COVID-19 to a tertiary hospital in Madrid, Spain from March 1st through March 30th, 2020, with a glycemia-corrected serum sodium level (SNa) < 135 mmol/L. Variables were collected at admission, at 2nd-3rd day of hospitalization, and ensuing days when hyponatremia persisted. Admission volemia (based on both physical and analytical parameters), therapy, and its adequacy as a function of volemia, were determined.ResultsAge: 68 years [56-81]; 39.9% were female. Median admission SNa was 133 mmol/L [131- 134]. Hyponatremia was mild (SNa 131-134 mmol/L) in 188/247 (76%). Volemia was available in 208/247 patients; 57.2% were euvolemic and the rest (42.8%) hypovolemic. Hyponatremia was left untreated in 154/247 (62.3%) patients. Admission therapy was not concordant with volemia in 43/84 (51.2%). In fact, the majority of treated euvolemic patients received incorrect therapy with isotonic saline (37/41, 90.2%), whereas hypovolemics did not (p=0.001). The latter showed higher mortality rates than those receiving adequate or no therapy (36.7% vs. 19% respectively, p=0.023). The administration of isotonic saline to euvolemic hyponatremic subjects was independently associated with an elevation of in-hospital mortality (Odds Ratio: 3.877, 95%; Confidence Interval: 1.25-12.03).ConclusionHyponatremia in COVID-19 is predominantly euvolemic. Isotonic saline infusion therapy in euvolemic hyponatremic COVID-19 patients can lead to an increased mortality rate. Thus, an exhaustive and precise volemic assessment of the hyponatremic patient with CAP, particularly when due to COVID-19, is mandatory before instauration of therapy, even when hyponatremia is mild.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Inappropriate therapy of euvolemic hyponatremia, the most frequent type of hyponatremia in SARS-CoV-2 infection, is associated with increased mortality in COVID-19 patients

Pazos-Guerra,

Ruiz-Sánchez,

Pérez-Candel

et al. 2023

Front. Endocrinol.

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Longitudinal analysis of electrolyte prolife in intensive care COVID-19 patients

Abosamak

Szergyuk

Oliveira

et al. 2023

Egyptian Journal of Anaesthesia

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What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals

de Haan,

ten Wolde,

Beudel

et al. 2023

BMJ Open

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ObjectivesTo evaluate the relationship among dysnatraemia at hospital presentation and duration of admission, risk of intensive care unit (ICU) admission and all-cause mortality and to assess the underlying pathophysiological mechanism of hyponatraemia in patients with COVID-19. Our hypothesis is that both hyponatraemia and hypernatraemia at presentation are associated with adverse outcomes.DesignObservational study.SettingSecondary care; 11 Dutch hospitals (2 university and 9 general hospitals).ParticipantsAn analysis was performed within the retrospective multicentre cohort study COVIDPredict. 7811 patients were included (60% men, 40% women) between 24 February 2020 and 9 August 2022. Patients who were ≥18 years with PCR-confirmed COVID-19 or CT with COVID-19 reporting and data system score≥4 and alternative diagnosis were included. Patients were excluded when serum sodium levels at presentation were not registered in the database or when they had been transferred from another participating hospital.Outcome measuresWe studied demographics, medical history, symptoms and outcomes. Patients were stratified according to serum sodium concentration and urinary sodium excretion.ResultsHyponatraemia was present in 2677 (34.2%) patients and hypernatraemia in 126 (1.6%) patients. Patients with hyponatraemia presented more frequently with diarrhoea, lower blood pressure and tachycardia. Hyponatraemia was, despite a higher risk for ICU admission (OR 1.27 (1.11–1.46; p<0.001)), not associated with mortality or the risk for intubation. Patients with hypernatraemia had higher mortality rates (OR 2.25 (1.49–3.41; p<0.001)) and were at risk for ICU admission (OR 2.89 (1.83–4.58)) and intubation (OR 2.95 (1.83–4.74)).ConclusionsHypernatraemia at presentation was associated with adverse outcomes in patients with COVID-19. Hypovolaemic hyponatraemia was found to be the most common aetiology of hyponatraemia. Hyponatraemia of unknown aetiology was associated with a higher risk for ICU admission and intubation and longer duration of admission.

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Impacto de la corrección temprana de la hiponatremia en el pronóstico de la infección del síndrome respiratorio agudo grave del coronavirus 2 (SARS-CoV-2)

Cited by 3 publications

References 31 publications

Inappropriate therapy of euvolemic hyponatremia, the most frequent type of hyponatremia in SARS-CoV-2 infection, is associated with increased mortality in COVID-19 patients

Inappropriate therapy of euvolemic hyponatremia, the most frequent type of hyponatremia in SARS-CoV-2 infection, is associated with increased mortality in COVID-19 patients

Longitudinal analysis of electrolyte prolife in intensive care COVID-19 patients

What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals

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