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Multicenter Study
. 2021 Jun;16(4):853-862.
doi: 10.1007/s11739-020-02515-9. Epub 2020 Oct 16.

Disorders of sodium balance and its clinical implications in COVID-19 patients: a multicenter retrospective study

Weihua Hu #  1 , Xinke Lv #  2 , Chang Li #  3 , Yang Xu #  4 , Yiding Qi  5 , Zhuheng Zhang  6 , Mingxuan Li  5 , Feina Cai  5 , Dan Liu  1 , Jiang Yue  6 , Maoqing Ye  7 , Qijian Chen  8 , Kailei Shi  9
Affiliations
Multicenter Study

Disorders of sodium balance and its clinical implications in COVID-19 patients: a multicenter retrospective study

Weihua Hu et al. Intern Emerg Med. 2021 Jun.

Abstract

Background: The worldwide spread of SARS-CoV-2 has infected millions of people leading to over 0.3 million mortalities. The disruption of sodium homeostasis, tends to be a common occurrence in patients with COVID-19.

Methods and results: A total of 1,254 COVID-19 patients comprising 124 (9.9%) hyponatremic patients (under 135 mmol/L) and 30 (2.4%) hypernatremic patients (over 145 mmol/L) from three hospitals in Hubei, China, were enrolled in the study. The relationships between sodium balance disorders in COVID-19 patients, its clinical features, implications, and the underlying causes were presented. Hyponatremia patients were observed to be elderly, had more comorbidities, with severe pneumonic chest radiographic findings. They were also more likely to have a fever, nausea, higher leukocyte and neutrophils count, and a high sensitivity C-reactive protein (HS-CRP). Compared to normonatremia patients, renal insufficiency was common in both hyponatremia and hypernatremia patients. In addition, hyponatremia patients required extensive treatment with oxygen, antibiotics, and corticosteroids. The only significant differences between the hypernatremia and normonatremia patients were laboratory findings and clinical complications, and patients with hypernatremia were more likely to use traditional Chinese medicine for treatment compared to normonatremia patients. This study indicates that severity of the disease, the length of stay in the hospital of surviving patients, and mortality were higher among COVID-19 patients with sodium balance disorders.

Conclusion: Sodium balance disorder, particularly hyponatremia, is a common condition among hospitalized patients with COVID-19 in Hubei, China, and it is associated with a higher risk of severe illness and increased in-hospital mortality.

Keywords: COVID-19; Clinical implication; Hypernatremia; Hyponatremia; SARS-CoV-2; Sodium balance disorders.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves of patients with 3 levels of serum sodium
See this image and copyright information in PMC

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