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. 2020 Nov 30:11:599255.
doi: 10.3389/fendo.2020.599255. eCollection 2020.

Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis

Jorge Gabriel Ruiz-Sánchez  1 , Ivan J Núñez-Gil  1 , Martin Cuesta  1   2 , Miguel A Rubio  1 , Charbel Maroun-Eid  3 , Ramón Arroyo-Espliguero  4 , Rodolfo Romero  5 , Victor Manuel Becerra-Muñoz  6 , Aitor Uribarri  7 , Gisela Feltes  8 , Daniela Trabattoni  9 , María Molina  10 , Marcos García Aguado  11 , Martino Pepe  12 , Enrico Cerrato  13 , Emilio Alfonso  14 , Alex Fernando Castro Mejía  15 , Sergio Raposeiras Roubin  16 , Luis Buzón  17 , Elvira Bondia  18 , Francisco Marin  19 , Javier López Pais  20 , Mohammad Abumayyaleh  21 , Fabrizio D'Ascenzo  22 , Elisa Rondano  23 , Jia Huang  24 , Cristina Fernandez-Perez  1 , Carlos Macaya  1 , Paz de Miguel Novoa  1 , Alfonso L Calle-Pascual  1   2 , Vicente Estrada Perez  1 , Isabelle Runkle  1 ; HOPE COVID-19 investigators
Affiliations

Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis

Jorge Gabriel Ruiz-Sánchez et al. Front Endocrinol (Lausanne). .

Abstract

Dysnatremia is associated with increased mortality in patients with community-acquired pneumonia. SARS-COV2 (Severe-acute-respiratory syndrome caused by Coronavirus-type 2) pneumonia can be fatal. The aim of this study was to ascertain whether admittance dysnatremia is associated with mortality, sepsis, or intensive therapy (IT) in patients hospitalized with SARS-COV2 pneumonia. This is a retrospective study of the HOPE-COVID-19 registry, with data collected from January 1th through April 31th, 2020. We selected all hospitalized adult patients with RT-PCR-confirmed SARS-COV2 pneumonia and a registered admission serum sodium level (SNa). Patients were classified as hyponatremic (SNa <135 mmol/L), eunatremic (SNa 135-145 mmol/L), or hypernatremic (SNa >145 mmol/L). Multivariable analyses were performed to elucidate independent relationships of admission hyponatremia and hypernatremia, with mortality, sepsis, or IT during hospitalization. Four thousand six hundred sixty-four patients were analyzed, median age 66 (52-77), 58% males. Death occurred in 988 (21.2%) patients, sepsis was diagnosed in 551 (12%) and IT in 838 (18.4%). Hyponatremia was present in 957/4,664 (20.5%) patients, and hypernatremia in 174/4,664 (3.7%). Both hyponatremia and hypernatremia were associated with mortality and sepsis. Only hyponatremia was associated with IT. In conclusion, hyponatremia and hypernatremia at admission are factors independently associated with mortality and sepsis in patients hospitalized with SARS-COV2 pneumonia.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04334291, NCT04334291.

Keywords: COVID-19; SARS-COV2; hypernatremia; hyponatremia; mortality; sepsis.

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Conflict of interest statement

IR and MC have given talks sponsored by Otsuka, and worked in an advisor capacity for Otsuka. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Algorithm of the selection of patients for the study.
Figure 2
Figure 2
Hazzard Ratios for mortality according to serum sodium in the entire group of patients. Developed with a Univariate Cox regression analysis.
Figure 3
Figure 3
(A) Factors associated with Mortality in hyponatremic vs eunatremic patients in the Multivariable logistic regression model; (B) Factors associated with Sepsis in hyponatremic vs eunatremic patients in the Multivariable logistic regression model. CKD, chronic kidney disease; CV, cardiovascular disease; ACEi, angiotensin-converting enzyme inhibitors; ARB, angiotensin-2 receptor blockers; OS, capillary or arterial oxygen saturation; SC, serum creatinine.
Figure 4
Figure 4
(A) Factors associated with Mortality in hypernatremic vs eunatremic patients in the Multivariable logistic regression model; (B) Factors associated with Sepsis in hypernatremic vs eunatremic patients in the Multivariable logistic regression model. DM, diabetes mellitus; OS, capillary or arterial oxygen saturation; SC, serum creatinine.
Figure 5
Figure 5
Kaplan-Meier Survival curve according to natremia. *Calculated median of survival (95% CI), p < 0.001.
See this image and copyright information in PMC

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