Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis

Abstract

Dysnatremia is associated with increased mortality in patients with community-acquired pneumonia. SARS-COV2 (Severe-acute-respiratory syndrome caused by Coronavirus-type 2) pneumonia can be fatal. The aim of this study was to ascertain whether admittance dysnatremia is associated with mortality, sepsis, or intensive therapy (IT) in patients hospitalized with SARS-COV2 pneumonia. This is a retrospective study of the HOPE-COVID-19 registry, with data collected from January 1th through April 31th, 2020. We selected all hospitalized adult patients with RT-PCR-confirmed SARS-COV2 pneumonia and a registered admission serum sodium level (SNa). Patients were classified as hyponatremic (SNa <135 mmol/L), eunatremic (SNa 135–145 mmol/L), or hypernatremic (SNa >145 mmol/L). Multivariable analyses were performed to elucidate independent relationships of admission hyponatremia and hypernatremia, with mortality, sepsis, or IT during hospitalization. Four thousand six hundred sixty-four patients were analyzed, median age 66 (52–77), 58% males. Death occurred in 988 (21.2%) patients, sepsis was diagnosed in 551 (12%) and IT in 838 (18.4%). Hyponatremia was present in 957/4,664 (20.5%) patients, and hypernatremia in 174/4,664 (3.7%). Both hyponatremia and hypernatremia were associated with mortality and sepsis. Only hyponatremia was associated with IT. In conclusion, hyponatremia and hypernatremia at admission are factors independently associated with mortality and sepsis in patients hospitalized with SARS-COV2 pneumonia.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT04334291, NCT04334291.

Dysnatremia in Covid -19 Disease Characteristics of Patients, Clinical Manifestation and Outcome in Pakistan.

“…Indirect stimulation of IL-6 is mediated by an injury to the alveolar basement membrane, resulting in activation of hypoxic pulmonary vasoconstriction pathway that lead ADH release61 (17).On the contrary, IHD was signi cantly associated with hyponatremia than hypernatremia. This association is also reported in HOPE -COVID-19 registry (16) In our population, sodium metabolism was affected by the complications of covid-19 infection, like AKI and TEE. We found that, the patients who had AKI developed hypernatremia 5.5 times more as compared to those who did not have AKI.…”

“…In our study, hypertension was signi cantly associated with hypernatremia, although hyponatremia was also common but didn't reach to a signi cant level. Ruiz and Cuesta in HOPE-COVID-19 registry analysis also found signi cant association of hypernatremia in hypertensive patients, the mechanism of this nding is not evident and it will need further evaluation (16). The hyponatremia on the other hand is also reportedly associated with covid hypertensive patients.…”

“…However in a registry analysis Sanchez et al found hyponatremia as an independent risk factor for an increase in mortality as well as for an increase in the development of sepsis and requirement for intensive therapy. The reason of their nding might be due to relatively larger sample size of their study (16).…”

Management of hyponatraemia and hypernatraemia during the Covid-19 pandemic: a consensus statement of the Spanish Society for Endocrinology (Acqua Neuroendocrinology Group)

“…Hypernatraemia is a common laboratory abnormality in COVID-19 patients, found in 3,7% of patients hospitalised due to COVID-19 in the HOPE registry [9]. Similarly to hyponatraemia, increased plasma sodium levels are an adverse prognostic factor in non-COVID patients although this awaits confirmation in COVID-19 series.…”

“…A number of case reports describing hyponatraemia of various etiologies was initially published [4][5][6][7]. Later, a descriptive study of 16 patients with COVID-19-related hospitalization found 50% of them had hyponatraemia [8], whereas the HOPE study, an international registry of 4664 hospitalized COVID-19 patients, found that 20.5% and 3.7% had hyponatraemia and hypernatraemia, respectively [9]: both hyponatraemia and hypernatraemia were generally mild (130-134 mEq/l in 16.7%), severe hyponatraemia (<120 mEq/l) was found only in 0.4%. Multivariable logistic regression analysis showed that male sex and age > 70 years were independently associated with hyponatraemia at admission, whereas smoking, tachypnea and serum creatinine >1.5 mg/dl bore a positive, independent association with admission hypernatraemia.…”