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Observational Study
. 2023 Mar;46(3):577-586.
doi: 10.1007/s40618-022-01938-9. Epub 2022 Oct 25.

Relationship between hyponatremia at hospital admission and cardiopulmonary profile at follow-up in patients with SARS-CoV-2 (COVID-19) infection

D Malandrino  1 , A Berni  2 , B Fibbi  3   4 , B Borellini  5 , D Cozzi  6 , D Norello  3   4 , F Fattirolli  1   7 , F Lavorini  1 , I Olivotto  1   8 , C Fumagalli  1   8 , C Zocchi  1   8 , L Tassetti  1   8 , L Gozzi  6 , N Marchionni  1 , M Maggi  3   5 , A Peri  9   10   11 ; AOU Careggi COVID-19 Follow-up Study Group
Collaborators, Affiliations
Observational Study

Relationship between hyponatremia at hospital admission and cardiopulmonary profile at follow-up in patients with SARS-CoV-2 (COVID-19) infection

D Malandrino et al. J Endocrinol Invest. 2023 Mar.

Abstract

Purpose: Hyponatremia occurs in about 30% of patients with pneumonia, including those with SARS-CoV-2 (COVID-19) infection. Hyponatremia predicts a worse outcome in several pathologic conditions and in COVID-19 has been associated with a higher risk of non-invasive ventilation, ICU transfer and death. The main objective of this study was to determine whether early hyponatremia is also a predictor of long-term sequelae at follow-up.

Methods: In this observational study, we collected 6-month follow-up data from 189 laboratory-confirmed COVID-19 patients previously admitted to a University Hospital. About 25% of the patients (n = 47) had hyponatremia at the time of hospital admission.

Results: Serum [Na+] was significantly increased in the whole group of 189 patients at 6 months, compared to the value at hospital admission (141.4 ± 2.2 vs 137 ± 3.5 mEq/L, p < 0.001). In addition, IL-6 levels decreased and the PaO2/FiO2 increased. Accordingly, pulmonary involvement, evaluated at the chest X-ray by the RALE score, decreased. However, in patients with hyponatremia at hospital admission, higher levels of LDH, fibrinogen, troponin T and NT-ProBNP were detected at follow-up, compared to patients with normonatremia at admission. In addition, hyponatremia at admission was associated with worse echocardiography parameters related to right ventricular function, together with a higher RALE score.

Conclusion: These results suggest that early hyponatremia in COVID-19 patients is associated with the presence of laboratory and imaging parameters indicating a greater pulmonary and right-sided heart involvement at follow-up.

Keywords: Follow-up; Hyponatremia; Outcome; Pneumonia; SARS-CoV-2 (COVID-19) infection; SIAD.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Fig. 1
Fig. 1
Flowchart of the study design
Fig. 2
Fig. 2
Linear regression for P/F ratio as a function of RALE score at admission in hyponatremic patients, normonatremic patients and in the total group of patients. P/F: PaO2/FiO2 ratio
See this image and copyright information in PMC

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