Patients hospitalized with COVID-19 are more likely to have sodium abnormalities at admission compared with those without COVID-19, and these abnormalities are associated with worse outcomes, including acute kidney injury (AKI) and death, according to separate studies presented during the American Society of Nephrology’s Kidney Week 2021.
In a study that included 5712 adult patients with COVID-19 hospitalized in 2020 for at least 24 hours, a team led by Lili Chan, MD, MS, of the Icahn School of Medicine in New York, New York, found that both hypo- and hypernatremia on hospital admission and during hospitalization for COVID-19 were independently associated with in-hospital mortality, AKI, and need for an invasive mechanical ventilation (IMV). Compared with non-COVID-19 cases with normonatremia hospitalized in 2019, COVID-19 cases with moderate or severe hyponatremia, mild hyponatremia, normonatremia, and hypernatremia at admission had significant 12.6-, 11.3-, 8.0-, and 23.4-fold increased odds of in-hospital mortality, respectively, and 2.4-, 1.7-, 1.3-, and 6.4-fold increased odds of AKI, respectively, after adjusting for demographics, comorbidities, and admission laboratory values. Patients with COVID-19 and moderate or severe hyponatremia, and mild hyponatremia at admission had 1.9- and 1.5-fold increased odds of IMV, respectively. Hypernatremia and normonatremia in COVID-19 cases were not associated with IMV.
During hospitalization, the COVID-19 group with moderate or severe hyponatremia, mild hyponatremia, normonatremia, and hypernatremia had significant 42.2-, 16.9-, 11.0-, and 87.2-fold increased odds of in-hospital mortality, respectively, 6.5-, 2.6-, 1.4-, and 9.1-fold increased odds of AKI, respectively, and 10.7-, 4.2-, 1.5-, and 2.2-fold increased odds of IMV, respectively, compared with the normonatremic non-COVID-19 group.
“It is highly likely that dysnatremias are a marker for severity of illness and not cause for the adverse outcomes in COVID-19,” Dr Chan’s team concluded in a poster presentation.
The investigators defined moderate or severe hyponatremia as serum sodium levels less than 130 mEq/L, mild hyponatremia as levels of 130-134 mEq/L, and hypernatremia as levels higher than 145 mEq/L.
The study’s first author, Pattharawin Pattharanitima, MD, told Renal & Urology News: “Although dysnatremia could possibly be either a marker of disease severity or a contributor of worse clinical outcomes, physicians should be alerted to any dysnatremia in hospitalized COVID-19 patients in order to prevent subsequent unfavorable results.”
In another study, Chetan Potu, MD, of Stony Brook University Renaissance School of Medicine in Stony Brook, New York, and colleagues demonstrated that sodium abnormalities at hospital admission were more common among patients with vs without COVID-19 (hyponatremia 26.7% vs 16.2% and hypernatremia 4.2% vs 1.3%). Abnormal sodium levels in patients with COVID-19 was associated with increased mortality. Patients with COVID-19 had increased risks for admission to an intensive care unit (ICU), need for intubation, and acute respiratory distress syndrome (ARDS).
Among patients with COVID-19, both hyponatremia and hypernatremia were significantly associated with increased odds of mortality compared with normonatremia, the investigators concluded. Hyponatremia also was significantly associated with increased odds of ICU admission, intubation, and ARDS.
The study included 1703 patients with COVID-19 and 3586 without it. Based on sodium levels at the time of hospitalization, the investigators defined hyponatremia as sodium levels less than 135 mEq/L, normonatremia as levels of 135-145 mEq/L, and hypernatremia as levels above 145 mEq/L.
Pattharanitima P, Chauhan K, Coca SG, Nadkarni GN, Chan L. Prevalence and association of dysnatremia with outcomes in hospitalized COVID-19 patients. Presented at: Kidney Week 2021, November 2-7, 2021. Abstract PO0076.
Potu C, Nataraj N, Mallipattu SK, Koraishy FM, Arbeit LA. Association of sodium abnormalities with outcomes in hospitalized patients with and without COVID-19. Presented at: Kidney Week 2021, November 2-7, 2021. Abstract PO0074.