Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 23;101(51):e32535.
doi: 10.1097/MD.0000000000032535.

Association of hypernatremia with outcomes of COVID-19 patients: A protocol for systematic review and meta-analysis

Abhigan Babu Shrestha  1 , Unnat Hamal Sapkota  1 , Sajina Shrestha  2 , Manjil Aryal  1 , Swati Chand  3 , Sangharsha Thapa  4 , Faisal Chowdhury  5 , Abdullah Salman  6 , Shumneva Shrestha  7 , Sangam Shah  7 , Vikash Jaiswal  8
Affiliations

Association of hypernatremia with outcomes of COVID-19 patients: A protocol for systematic review and meta-analysis

Abhigan Babu Shrestha et al. Medicine (Baltimore). .

Abstract

Background: This systematic review and meta-analysis aimed to assess the association of hypernatremia with the outcomes of COVID-19 patients.

Methods: We performed a systematic literature search on PubMed, Google Scholar, and Science Direct until October 2021 and found a total of 131 papers. With meticulous screening finally, 17 papers met the inclusion criteria. COVID-19 patients with sodium levels greater than the reference level were the study population and the outcome of interest was the poor outcome; such as mortality, mechanical ventilation, intensive care unit (ICU) admission, and prolonged hospital stay. The pooled estimate was calculated as the odds ratio (OR).

Results: There were 19,032 patients with hypernatremia in the 17 studies included. An overall random effect meta-analysis showed that hypernatremia was associated with mortality (OR: 3.18 [1.61, 6.28], P < .0001, I2 = 91.99%), prolong hospitalization (OR: 1.97 [1.37, 2.83], P < .001, I2 = 0.00%) and Ventilation (OR: 5.40 [1.89, 15.42], P < .001, I2 = 77.35%), ICU admission (OR: 3.99 [0.89, 17.78], P = .07, I2 = 86.79%). Meta-regression analysis showed the association of age with the ICU outcome of hypernatremia patients. Whereas, other parameters like male, hypertension, chronic kidney disease, and diabetes mellitus did not significantly influence the odds ratio.

Conclusion: Hypernatremia was markedly associated with poor outcomes in patients with COVID-19. Hence, a blood ionogram is warranted and special attention must be given to hypernatremia COVID-19 patients.

PubMed Disclaimer

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
PRISMA flowchart for study selection.
Figure 2.
Figure 2.
Forestplot showing association of hypernatremia in COVID-19 patients with mortality.
Figure 3.
Figure 3.
Forestplot showing association of hypernatremia in COVID-19 patients with with prolonged hospital stay.
Figure 4.
Figure 4.
Forestplot showing association of hypernatremia in COVID-19 patients with ventilation.
Figure 5.
Figure 5.
Forestplot showing association of hypernatremia in COVID-19 patients with ICU admission. ICU = intensive care unit.
Figure 6.
Figure 6.
Potential mechanism of hypernatremia. ACE 2 = angiotensin-converting enzyme 2, Ang II = angiotensin II, AT1 = angiotensin II receptor type 1, ADH = anti-diuretic hormone, V2R = vasopressin 2 receptor, AQP-2 = aquaporin 2.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lim MA, Pranata R, Huang I, et al. . Multiorgan failure with emphasis on acute kidney injury and severity of COVID-19: systematic review and meta-analysis. Can J Kidney Health Dis. 2020;7:2054358120938573. - PMC - PubMed
    1. Pan D, Sze S, Minhas JS, et al. . The impact of ethnicity on clinical outcomes in COVID-19: a systematic review. eClinicalMedicine. 2020;23:100404. - PMC - PubMed
    1. Grasselli G, Greco M, Zanella A, et al. . Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180:1345–55. - PMC - PubMed
    1. Gupta S, Hayek SS, Wang W, et al. . Factors associated with death in critically Ill patients with coronavirus disease 2019 in the US. JAMA Intern Med. 2020;180:1–12. - PMC - PubMed
    1. Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE, et al. . Predicting mortality due to SARS-CoV-2: a mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico. J Clin Endocrinol Metab. 2020;105:dgaa346. - PMC - PubMed