Abstract
This review examines the prevalence, aetiology, pathophysiology, prognostic value, and investigation of dysnatraemia in hospitalised COVID-19 patients, taking into account all relevant studies published in PubMed and Cochrane Library studies until March 2021. Hyponatraemia is commonly observed in patients with bacterial pneumonia and is an independent predictor for excess mortality and morbidity. However, it remains unknown whether this association applies to coronavirus disease-2019 (COVID-19). Several studies reported a 20–35% prevalence for hyponatraemia and 2–5% for hypernatraemia in patients admitted with COVID-19. In addition, hyponatraemia on admission was a risk factor for progression to severe disease, being associated with an increased likelihood for the need for invasive mechanical ventilation, with an odds ratio (OR) of 1.83–3.30. Hyponatraemia seems to be an independent risk factor for mortality, with an OR of 1.40–1.50 compared to normonatraemia, while hypernatraemia is related to even worse outcomes than hyponatraemia. Furthermore, preliminary data show an inverse association between serum sodium and interleukin-6 levels, suggesting that hyponatraemia might be used as a surrogate marker for the risk of a cytokine storm and the need for treatment with interleukin antagonists. In conclusion, dysnatraemia is common and carries a poor prognosis in COVID-19 patients, indicating that it may play a future role in risk stratification and individualising therapy.
Highlights
Numerous studies have demonstrated a U-shaped relationship between serum sodium concentration and in-patient mortality in general hospital populations, with both hyponatraemia and hypernatraemia being independent risk factors for mortality (1, 2)
A significant proportion of patients with COVID-19 are hospitalised with viral pneumonia which can progress to severe disease, characterised by various types of organ dysfunction, including septic shock, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), acute cardiac injury, neurological complications (6), and disseminated intravascular coagulation (DIC) (7)
We summarise the literature to date with regards to the prevalence, aetiology, and prognostic value of alterations in serum sodium levels in hospitalised patients with COVID-19
Summary
Numerous studies have demonstrated a U-shaped relationship between serum sodium concentration and in-patient mortality in general hospital populations, with both hyponatraemia and hypernatraemia (defined as serum sodium levels below 135 mmol/L and above 145 mmol/L, respectively) being independent risk factors for mortality (1, 2). Of the numerous studies flagged up, only six were found to have examined the prevalence of sodium abnormalities, and their association with clinical outcomes in COVID-19 patients (Table 1), which are reviewed in detail below.
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