Sex differences in electrolyte imbalances caused by SARS‐CoV‐2: A cross‐sectional study

Abstract

Background Since SARS‐CoV‐2 spread, evidence regarding sex differences in progression and prognosis of COVID‐19 have emerged. Besides this, studies on patients' clinical characteristics have described electrolyte imbalances as one of the recurrent features of COVID‐19. Methods We performed a cross‐sectional study on all patients admitted to the emergency department (ED) from 1 March to 31 May 2020 who had undergone a blood gas analysis and a nasopharyngeal swab test for SARS‐CoV‐2 by rtPCR. We defined positive patients as cases (n = 710) and negatives as controls (n = 619), for a total number of patients of 1.329. The study was approved by the local ethics committee Area 3 Milan. Data were automatically extracted from the hospital laboratory SQL‐based repository in anonymised form. We considered as outcomes potassium (K + ), sodium (Na + ), chlorine (Cl − ) and calcium (Ca ++ ) as continuous and as categorical variables, in their relation with age, sex and SARS‐CoV‐2 infection status. Results We observed a higher prevalence of hypokalaemia among patients positive for SARS‐CoV‐2 (13.7% vs 6% of negative subjects). Positive patients had a higher probability to be admitted to the ED with hypokalaemia (OR 2.75, 95% CI 1.8‐4.1, P < .0001) and women were twice as likely to be affected than men (OR 2.43, 95% CI 1.67‐3.54, P < .001). Odds ratios for positive patients to manifest with an alteration in serum Na + was (OR 1.6, 95% CI 1.17‐2.35, P < .001) and serum chlorine (OR 1.6, 95% CI 1.03‐2.69, P < .001). Notably, OR for positive patients to be hypocalcaemic was 7.2 (95% CI 4.8‐10.6, P < .0001) with a low probability for women to be hypocalcaemic (OR 0.63, 95% CI 0.4‐0.8, P = .005). Conclusions SARS‐CoV‐2 infection is associated with a higher prevalence of hypokalaemia, hypocalcaemia, hypochloraemia and sodium alterations. Hypokalaemia is more frequent among women and hypocalcaemia among men.

The Correlation Between Hypocalcemia and Clinical Level of Covid-19 Patients at Sebelas Maret University Hospital

“…Hypocalcemia cases with Covid-19 in male patients were between 28% to 34% than female patients, namely 16% to 32%. This difference was associated with the vitamin D or calcium supplements consumption in women who are more often for osteoporosis prevention 11 .…”

A Rare Cause of Transient Proximal Tubule Dysfunction: COVID-19

“…8 In addition, SARS-CoV-2 may affect sodium and potassium transport via Na+/K+ ATPase in renal tubular epithelium through ACE2-related renin-angiotensin system activation. 9 Post-mortem studies in patients who died due to COVID-19 revealed the presence of significant acute tubular injury in light microscopy, while the presence of viral particles in both tubular epithelium and podocytes was shown in electron microscopy, which has been attributed to direct infection of the kidneys by COVID-19. 10,11 In a study conducted in France, it was suggested that the findings of proteinuria, hypophosphatemia, hypouricemia, and glycosuria are common in patients who developed proximal tubule damage due to COVID-19 and that these findings can be used as markers of proximal tubule damage.…”

The association between dysnatraemia during hospitalisation and post COVID-19 mental fatigue

“…Recent studies have highlighted sex differences in electrolyte imbalances caused by SARS-CoV-2 at the acute phase 7 . Moreover, such electrolyte patterns have been associated with COVID-19 disease in hospitalised patients 8 .…”

“…Furthermore, as long COVID symptoms are more likely to occur in females 4 , we expected that patients’ sex might interact with the disease severity in the odds of persistent cognitive difficulties. Lastly, as electrolyte imbalances are one of the recurrent features of COVID-19, and it differs between males and females 7 , we hypothesised that the odds of cognitive failures could be associated with the electrolyte profile during the hospitalisation, particularly in female patients.…”

“…Lastly, as electrolyte imbalances are one of the recurrent features of COVID-19, and it differs between males and females 7 , we hypothesised that the odds of cognitive failures could be associated with the electrolyte profile during the hospitalisation, particularly in female patients.…”