Prevalence and outcome of dysnatremia in patients with COVID-19 compared to controls

Abstract

Objective: The pandemic of coronavirus disease (COVID-19) has rapidly spread globally and infected millions of people. The prevalence and prognostic impact of dysnatremia in COVID-19 is inconclusive. Therefore, we investigated the prevalence and outcome of dysnatremia in COVID-19. Design: The prospective, observational, cohort study included consecutive patients with clinical suspicion of COVID-19 triaged to a Swiss Emergency Department between March and July 2020. Methods: Collected data included clinical, laboratory and disease severity scoring parameters on admission. COVID-19 cases were identified based on a positive nasopharyngeal swab test for SARS-CoV-2, patients with a negative swab test served as controls. The primary analysis was to assess the prognostic impact of dysnatremia on 30-day mortality using a cox proportional hazard model. Results: 172 (17%) cases with COVID-19 and 849 (83%) controls were included. Patients with COVID-19 showed a higher prevalence of hyponatremia compared to controls (28.1% vs. 17.5%, p<0.001); while comparable for hypernatremia (2.9% vs 2.1%, p=0.34). In COVID-19 but not in controls, hyponatremia was associated with a higher 30-day mortality (HR 1.4, 95%-CI 1.10-16.62, p=0.05). In both groups, hypernatremia on admission was associated with higher 30-day mortality (COVID-19: HR 11.5, 95%-CI 5.00-26.43, p<0.001; controls: HR 5.3, 95%-CI 1.60-17.64, p=0.006). In both groups, hyponatremia and hypernatremia were significantly associated with adverse outcome, e.g. intensive care unit admission, longer hospitalization, and mechanical ventilation. Conclusion: Our results underline the importance of dysnatremia as predictive marker in COVID-19. Treating physicians should be aware and appropriate treatment measures taken in patients with COVID-19 and dysnatremia.

COVID-19 and dysnatremia: A comparison between COVID-19 and non-COVID-19 respiratory illness

“…Interestingly, whereas almost two of every five COVID-19 patients developed hypernatremia, this occurred in only 8% of the non-COVID-19 respiratory illness patients. This finding contradicts earlier work by-among others-Atila et al, 5 who found that the occurrence of hypernatremia was comparable among their COVID-19 group and control group, and Hirsch et al, 6 who found a compound hypernatremia prevalence of only 7% (3.2% for mild hypernatremia, defined as a plasma sodium concentration between 145 and 149 mmol/L, and 3.8% for severe hypernatremia, defined as a plasma sodium concentration of 150 mmol/L or above) in a large cohort of 9946 COVID-19 patients. Similar hypernatremia prevalence numbers have been reported by other authors.…”

ENDOCRINOLOGY IN THE TIME OF COVID-19-2021 UPDATES: The management of diabetes insipidus and hyponatraemia

“…Initial data suggested that hypernatraemia, in contrast to other critically ill patients, is not a risk factor for severe mortality in COVID-19 25 . More recent data, however, show that hypernatraemia is associated with adverse outcomes and mortality, similar to other critically ill patients [4][5][6][7] .…”

“…Especially patients with central diabetes insipidus (DI) or pre-existing hyponatraemia may be at risk of more severe, life threatening dysnatraemia. Regardless of pre-existing endocrine conditions, hyponatraemia is common in patients hospitalized with COVID-19 [2][3][4][5][6][7][8][9] and is associated with disease severity and mortality. This article is intended to advise how endocrinologists can still optimally care for ambulatory patients with central DI and hyponatraemia, where regular physical consultations and biochemical assessments are not possible.…”

The evolution of hypovolemic and euvolemic hyponatremia coincides with an inflammatory status in patients with COVID-19

“…Therefore, in agreement with Berni et al, we suspect that hyponatremia is another sign of a major severity in COVID-19 patients, which is depending of the in ammatory involvement affecting respiratory function. In fact, higher respiratory rates (4,5)and lower oxygen levels (4) have been reports as more frequent in hyponatremic than eunatremic COVID-19 patients.…”

“…As in pneumonia caused by other infections (11,12), hyponatremia is also a risk factor for a poor hospital prognosis in patients with COVID-19 pneumonia (4,5,9,13). In fact, a lower SNa at admission have been related with a higher risk for mortality (5).…”