Hyponatremia: More than just an electrolyte for COVID-19 patients

Year 2023, Volume: 37 Issue: 2, 97 - 109, 06.09.2023

Serpil Müge Değer , Emre Yasar , Hasan Selçuk Özger , Pınar Aysert Yıldız , Ulver Derici

https://doi.org/10.18614/deutip.1218114

Abstract

AIM: Hyponatremia is the most common electrolyte disturbance among infections, especially with pneumonia. Here, we aimed to analyze the presence of hyponatremia among COVID-19 patients along with its relation to mortality.
MATERIALS and METHODS: Patients were divided into two groups COVID-19 negative and positive and also another group with pneumonia and without pneumonia for covid-19 PCR positive patients. The association between hyponatremia and in-hospital mortality from any cause was evaluated with univariate and multivariate cox regression model.
RESULTS: A total of 636 patients, a mean age of 50± 18 years, 48 % of the female with a median duration of hospitalization of 5.5 (IQR, 2,11) days were included. Of those 553 (%87) were detected COVID-19 PCR positive and 298 (47%) of those with pneumonia. The median serum sodium concentration was lower in COVID-19 PCR positive patients [134 (IQR, 130,137) mEq/L] compared to negatives [139 (IQR, 136, 140) mEq/L] (p<0.001). The median serum sodium levels were significantly lower in patients with pneumonia [136 (IQR, 133.138) mEq/L] than without pneumonia [139 (IQR, 137, 145) mEq/L] (p<0.001). All deaths occurred in patients with pneumonia [(n=40 (13.4 %)]. Patients with hyponatremia had increased mortality on unadjusted (OR, 3.85, 95%CI: 1.73, 8.53, P<0.001) and adjusted [OR, 3.58, 95%CI: 1.58, 8.1, P=0.002] in Cox proportional hazard models
CONCLUSION: Hyponatremia at admission is prevalent and an independent risk factor for in-hospital mortality among COVID-19 patients particularly those with pneumonia. It might be an important laboratory clue for both the diagnosis and survive of these patients.

Keywords

COVID-19, hyponatremia, pneumonia, mortality

Hiponatremi:COVID-19 hastaları için elektrolitden daha fazlası

Abstract

AMAÇ: Hiponatremi özellikle pnömonisi olan hasta grubunda sık rastlanan bir elektrolit anomalisidir. Biz bu çalışmada, COVID-19 pozitif hasta grubunda hiponatremi sıklığı ile mortalite arasındaki ilişkiyi değerlendirmeyi hedefledik.
METOD: Hastalar COVID-19 PCR pozitif, negatif ve COVID-19 PCR pozitif hastalar ise kendi içinde pnömoni olan ve olmayanlar olarak gruplara ayrıldı. Hiponatremi ve mortalite arasındaki ilişki tek değişkenli ve çok değişkenli COX regresyon analizi ile incelendi.
SONUÇLAR: Ortalama yaşı 50± 18 yıl olan 636 hasta çalışmaya dahil edildi. Hastaların %, 48'i kadın ve ortanca hastanede yatış süreleri ise 5.5 (IQR, 2,11) gündü. Hastaların 553 (%87) 'ünde COVID-19 PCR pozitif, ve pozitif hastaların 298'inde (%47) pnömoni saptandı. Ortanca serum sodyum konsantrasyonu COVID-19 PCR pozitif [134 (IQR, 130,137) mEq/L] hastalarda, negatif [139 (IQR, 136, 140) mEq/L] (p<0.001) olan hastalara göre düşük saptandı. COVID-19 PCR pozitif hasta grubu içinde pnömoni hasta grubunda [136 (IQR, 133.138) mEq/L]serum sodyum konsantrasyonu pnömoni olmayan[139 (IQR, 137, 145) mEq/L] (p<0.001) gruba göre istatistiksel olarak anlamlı düzeyde düşük saptandı Tüm ölümler pnömoni ile başvuran hasta grubunda izlendi [(n=40 (13.4 %)]. Hiponatremi hem tek değişkenli (OR, 3.85, 95%CI: 1.73, 8.53, P<0.001) hem de çok değişkenli [OR, 3.58, 95%CI: 1.58, 8.1, P=0.002] Cox regresyon modelinde mortalite için bağımsız bir risk faktörü olduğu görüldü.
TARTIŞMA: Hastaneye başvuran COVID-19 PCR pozitif hastalarda özellikle pnömoni saptanan grupta hiponatremi sık görülmekte ve mortalite için bağımsız bir risk faktörü olarak izlenmektedir. Bu hasta grubunda prognozun belirlenmesi açısından hiponatremi önemli bir laboratuvar parametresi olarak görev yapabilir.

Keywords

COVID-19, Hiponatremi, pnömoni, mortalite

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