Tezcan M E, Dogan Gokce G, Sen N, Zorlutuna Kaymak N, Ozer R S
Department of Rheumatology, Kartal Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
Department of Ophthalmology, Kartal Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
New Microbes New Infect. 2020 Sep;37:100753. doi: 10.1016/j.nmni.2020.100753. Epub 2020 Sep 1.
Electrolyte abnormalities are not uncommon in coronavirus disease 2019 (COVID-19). Several studies have suggested that various electrolyte imbalances seem to have an impact on disease prognosis. However, no study has primarily focused on the effect of baseline electrolyte abnormalities on disease outcome. In this study, we assessed the validity of the hypothesis that baseline electrolyte imbalances may be related to unfavourable outcomes in hospitalized COVID-19 patients. Design of the study was retrospective and observational. We included 408 hospitalized individuals with COVID-19 over 18 years old. Baseline levels of sodium, potassium, calcium and chloride were assessed and the effects of abnormalities in these electrolytes on requirement for intensive care unit and mechanical ventilation, hospitalization duration and treatment outcome were evaluated. Patients were clustered based on electrolyte levels and clusters were compared according to outcome variables. Frequency of other severe disease indices was compared between the clusters. Lastly, we evaluated the independent factors related to COVID-19-associated deaths with multivariate analyses. In all, 228 (55.8%) of the patients had at least one electrolyte imbalance at baseline. Hyponatraemia was the most frequent electrolyte abnormality. Patients with hyponatraemia, hypochloraemia or hypocalcaemia had, respectively, more frequent requirement for intensive care unit and mechanical ventilation, higher mortality rate and longer hospitalization. The clusters associated with electrolyte abnormalities had unfavourable outcomes. Also, Clinical and laboratory features associated with severe disease were detected more often in those clusters. Hyponatraemia was an independent factor related to death from COVID-19 (OR 10.33; 95% CI 1.62-65.62; p 0.01). Furthermore, baseline electrolyte imbalances, primarily hyponatraemia, were related to poor prognosis in COVID-19 and baseline electrolyte assessment would be beneficial for evaluating the risk of severe COVID-19.
电解质异常在2019冠状病毒病（COVID-19）中并不少见。多项研究表明，各种电解质失衡似乎会对疾病预后产生影响。然而，尚无研究主要关注基线电解质异常对疾病结局的影响。在本研究中，我们评估了基线电解质失衡可能与COVID-19住院患者不良结局相关这一假设的有效性。本研究设计为回顾性观察性研究。我们纳入了408名18岁以上的COVID-19住院患者。评估了钠、钾、钙和氯的基线水平，并评估了这些电解质异常对重症监护病房需求、机械通气需求、住院时间和治疗结局的影响。根据电解质水平对患者进行聚类，并根据结局变量对聚类进行比较。比较各聚类之间其他严重疾病指标的频率。最后，我们通过多变量分析评估了与COVID-19相关死亡相关的独立因素。总共有228名（55.8%）患者在基线时至少存在一种电解质失衡。低钠血症是最常见的电解质异常。低钠血症、低氯血症或低钙血症患者分别对重症监护病房和机械通气的需求更频繁、死亡率更高且住院时间更长。与电解质异常相关的聚类有不良结局。此外，在这些聚类中更常检测到与严重疾病相关的临床和实验室特征。低钠血症是与COVID-19死亡相关的独立因素（比值比10.33；95%置信区间1.62 - 65.62；p = 0.01）。此外，基线电解质失衡，主要是低钠血症，与COVID-19的不良预后相关，基线电解质评估有助于评估重症COVID-19的风险。
