Hyponatremia is associated with poor outcome in COVID-19.

Hugo De Carvalho,Hélène Caillon,Nicolas Goffinet,Paul Le Turnier,Emmanuel Canet,Armine Rouhani,Lucile Figueres,Emmanuel Montassier,Maxime Bentoumi-Loaec,Guillaume Chapelet,Nesrine Benaouicha,Emmanuelle Papuchon,Thibault Letellier,Geoffrey Desvaux,Matilde Karakachoff

doi:10.1007/s40620-021-01036-8

Abstract

AimOur objective was to describe the impact of hyponatremia on the outcomes of COVID-19 patients [outcomes selected: intensive care unit (ICU) admission, mechanical ventilation or death].MethodsTwo groups of COVID-19 patients were retrospectively screened on the basis of plasma sodium level at admission: hyponatremic (sodium < 135 mM, n = 92) or normonatremic (sodium ≥ 135 mM, n = 198) patients. Pearson’s chi-2 (qualitative variables) and Student’s T tests (quantitative variables) were used to compare the two groups. A multiple logistic regression model was used to explore the association between patients’ clinical data and outcomes.ResultsHyponatremia was frequent but generally mild. There were more male patients in the hyponatremic group (p = 0.014). Pulmonary lesions on the first thoracic CT-scan performed during hospitalization were significantly more extensive in the hyponatremic group (p = 0.010). ICU admission, mechanical ventilation or death were significantly more frequent in hyponatremic compared to normonatremic patients (37 versus 14%; p < 0.001; 17 versus 6%; p = 0.003; 18 versus 9%, p = 0.042, respectively). Hyponatremia was an independent predictor of adverse outcomes (adjusted Odds-ratio: 2.77 [1.26–6.15, p = 0.011]).ConclusionsOur study showed an independent relationship between hyponatremia at admission and transfer to ICU, use of mechanical ventilation or death in COVID-19 patients. Hyponatremia may reflect the severity of underlying pulmonary lesions. Our results support the use of sodium levels as a simple bedside screening tool for the early identification of SARS-CoV-2 infected patients at high risk of poor outcome.

Highlights

As the severe acute respiratory syndrome (SARS)-CoV-2 infection spreads worldwide, the search for prognostic factors is essential in order to provide adapted care and improve patient survival
Risks of intensive care unit (ICU) admission, mechanical ventilation or death, were significantly higher in hyponatremic compared to normonatremic patients (Table 1)
Risk of all adverse outcomes was significantly higher in hyponatremic patients compared to normonatremic patients (41% versus 20%, p < 0.001) (Table 1 and Fig. 1)

Summary

Introduction

As the SARS-CoV-2 infection spreads worldwide, the search for prognostic factors is essential in order to provide adapted care and improve patient survival. Hyponatremia, has previously been described as an independent predictive factor of poor outcome in critically ill patients [9], as is the case in severe acute respiratory syndrome (SARS). This condition occurred in one third of the SARS-CoV-1 infected patients and was associated with poor prognosis [10, 11]. Recent studies demonstrated that hyponatremia was associated with poor outcome in COVID-19 but these studies did not include European patients [12, 13] and/or did not consider plasma sodium levels at admission [13]. The outcome of hyponatremia in European COVID-19 patients has not been extensively described

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