The impact of the correction of hyponatremia during hospital admission on the prognosis of SARS-CoV-2 infection

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.medcle.2021.07.021

Cited by 6 publications

(3 citation statements)

References 31 publications

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“…Additionally, information on the duration of hyponatraemia in participating patients was not provided. Exploring these aspects would have been valuable, as a previous study by de La Flor et al 61 demonstrated that persistent hyponatraemia (72–96 hours after admission) was associated with higher mortality in patients with COVID-19. Second, the variability in treatment protocols among the participating hospital may have influenced the outcome of patients in our study.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…knowledge, there are no randomized trials on the correction of dysnatremia in COVID-19 patients and its impact on illness severity, outcomes, and mortality. In one retrospective study, de La Flor, J.C. et al, found that the absence of correction of hyponatremia in the first 72-96 h is associated with higher mortality in COVID-19 patients [10]. According to a recent study carried out in the Wroclaw Medical University Hospital, sodium concentration could predict prolonged length of in-hospital stay in patients with atrial fibrillation [11].…”

Section: Possible Dysnatremia Predictorsmentioning

confidence: 99%

Dysnatremia in COVID-19 Patients—An Analysis of the COLOS Study

Królicka

Letachowicz

Adamik

et al. 2023

JCM

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Background: Sodium imbalance is one of the most common electrolyte disturbances encountered in the medical practice, and it may present with either hyponatremia or hypernatremia. Both sodium abnormalities are related with unfavorable outcomes. Objective: Elucidation of the prevalence of dysnatremia among COVID-19 patients and its impact on 30- and 90-day mortality and need for ICU admission was the goal. Design and participants: A single-center, retrospective, observational study was conducted. A total of 2026 adult, SARS-CoV-2 positive patients, admitted to Wroclaw University Hospital between 02.2020 and 06.2021, were included. On admission, patients were divided into groups: normonatremic (N), hyponatremic (L), and hypernatremic (H). Acquired data was processed, and Cox hazards regression and logistic regression were implemented. Key results: Hyponatremia on admission occurred in 17.47% (n = 354) of patients and hypernatremia occurred in 5.03% (n = 102). Dysnatremic patients presented with more comorbidities, used more drugs, and were statistically more often admitted to the ICU. Level of consciousness was the strongest predictor of ICU admission (OR = 1.21, CI: 1.16–1.27, p < 0.001). Thirty-day mortality was significantly higher in both the L and H groups (28.52%, p = 0.0001 and 47.95%, p < 0.0001, respectively), in comparison to 17.67% in the N group. Ninety-day mortality showed a similar trend in all study groups: 34.37% in the L group (p = 0.0001), 60.27% (p < 0.0001) in the H group, and 23.32% in the N group. In multivariable analyses, hypo- and hypernatremia were found to be independent predictors of 30- and 90-day mortality. Conclusions: Both hypo- and hypernatremia are strong predictors of mortality and disease severity in COVID-19 patients. Extraordinary care should be taken when dealing with hypernatremic, COVID-positive patients, as this group exhibits the highest mortality rates.

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“…In COVID-19 infections, hyponatremia can be a marker of the severity of the underlying pulmonary disease and an independent risk factor for intensive care admissions and mechanical ventilation [2,4]. Uncorrected COVID-19-associated hyponatremia after 72 to 96 hours of hospitalization has been associated with higher mortality [5].…”

Section: Introductionmentioning

confidence: 99%

Hyponatremia in COVID-19 Is Not Always Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH): A Case Series

Javaid¹,

Shan²,

Frederick³

et al. 2022

Cureus

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Hyponatremia is a common complication in COVID-19-positive patients and is associated with significant mortality and morbidity. Several cases of COVID-19-related hyponatremia secondary to the Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) have been reported in the literature, which might suggest that SIADH is almost always the underlying cause of hyponatremia in COVID-19 infections. However, COVID-19-related hyponatremia can have diverse underlying etiologies, similar to hyponatremia in non-COVID-19 patients, and requires a thorough assessment to reach a correct diagnosis and implement appropriate management.

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The impact of the correction of hyponatremia during hospital admission on the prognosis of SARS-CoV-2 infection

Cited by 6 publications

References 31 publications

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

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

Dysnatremia in COVID-19 Patients—An Analysis of the COLOS Study

Hyponatremia in COVID-19 Is Not Always Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH): A Case Series

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