Department of Neurology, NYU Grossman School of Medicine, New York, NY.
Department of Medical Center Information Technology, NYU Grossman School of Medicine, New York, NY.
Crit Care Med. 2020 Dec;48(12):e1211-e1217. doi: 10.1097/CCM.0000000000004605.
Hyponatremia occurs in up to 30% of patients with pneumonia and is associated with increased morbidity and mortality. The prevalence of hyponatremia associated with coronavirus disease 2019 and the impact on outcome is unknown. We aimed to identify the prevalence, predictors, and impact on outcome of mild, moderate, and severe admission hyponatremia compared with normonatremia among coronavirus disease 2019 patients.
Retrospective, multicenter, observational cohort study.
Four New York City hospitals that are part of the same health network.
Hospitalized, laboratory-confirmed adult coronavirus disease 2019 patients admitted between March 1, 2020, and May 13, 2020.
None.
Hyponatremia was categorized as mild (sodium: 130-134 mmol/L), moderate (sodium: 121-129 mmol/L), or severe (sodium: ≤ 120 mmol/L) versus normonatremia (135-145 mmol/L). The primary outcome was the association of increasing severity of hyponatremia and in-hospital mortality assessed using multivariable logistic regression analysis. Secondary outcomes included encephalopathy, acute renal failure, mechanical ventilation, and discharge home compared across sodium levels using Kruskal-Wallis and chi-square tests. In exploratory analysis, the association of sodium levels and interleukin-6 levels (which has been linked to nonosmotic release of vasopressin) was assessed. Among 4,645 patient encounters, hyponatremia (sodium < 135 mmol/L) occurred in 1,373 (30%) and 374 of 1,373 (27%) required invasive mechanical ventilation. Mild, moderate, and severe hyponatremia occurred in 1,032 (22%), 305 (7%), and 36 (1%) patients, respectively. Each level of worsening hyponatremia conferred 43% increased odds of in-hospital death after adjusting for age, gender, race, body mass index, past medical history, admission laboratory abnormalities, admission Sequential Organ Failure Assessment score, renal failure, encephalopathy, and mechanical ventilation (adjusted odds ratio, 1.43; 95% CI, 1.08-1.88; p = 0.012). Increasing severity of hyponatremia was associated with encephalopathy, mechanical ventilation, and decreased probability of discharge home (all p < 0.001). Higher interleukin-6 levels correlated with lower sodium levels (p = 0.017).
Hyponatremia occurred in nearly a third of coronavirus disease 2019 patients, was an independent predictor of in-hospital mortality, and was associated with increased risk of encephalopathy and mechanical ventilation.
肺炎患者中高达 30%存在低钠血症，且与发病率和死亡率的增加相关。目前尚不清楚与 2019 年冠状病毒病（COVID-19）相关的低钠血症的流行情况及其对结局的影响。我们旨在确定 COVID-19 患者入院时轻度、中度和重度低钠血症与正常钠血症相比的患病率、预测因素和对结局的影响。
回顾性、多中心、观察性队列研究。
四家位于同一医疗网络的纽约市医院。
2020 年 3 月 1 日至 2020 年 5 月 13 日期间住院、经实验室确诊的成年 COVID-19 患者。
无。
低钠血症分为轻度（钠：130-134mmol/L）、中度（钠：121-129mmol/L）或重度（钠：≤120mmol/L）与正常钠血症（135-145mmol/L）相比。主要结局是使用多变量逻辑回归分析评估低钠血症严重程度增加与院内死亡率的相关性。次要结局包括在钠水平之间使用 Kruskal-Wallis 和卡方检验评估脑病、急性肾损伤、机械通气和出院回家的发生率。在探索性分析中，评估了钠水平与白细胞介素-6 水平（与非渗透性抗利尿激素释放有关）之间的关联。在 4645 例患者就诊中，1373 例（30%）存在低钠血症（钠<135mmol/L），其中 374 例（27%）需要有创机械通气。轻度、中度和重度低钠血症分别发生在 1032 例（22%）、305 例（7%）和 36 例（1%）患者中。在校正年龄、性别、种族、体重指数、既往病史、入院实验室异常、入院序贯器官衰竭评估评分、肾衰竭、脑病和机械通气后，每一级低钠血症恶化的患者发生院内死亡的几率增加 43%（校正比值比，1.43；95%置信区间，1.08-1.88；p=0.012）。低钠血症严重程度的增加与脑病、机械通气以及出院回家的可能性降低相关（均p<0.001）。较高的白细胞介素-6 水平与较低的钠水平相关（p=0.017）。
近三分之一的 COVID-19 患者存在低钠血症，是院内死亡率的独立预测因素，并与脑病和机械通气风险增加相关。
