Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
University of Basel, Department of Clinical Research, Basel, Switzerland.
Eur J Endocrinol. 2021 Mar;184(3):409-418. doi: 10.1530/EJE-20-1374.
The pandemic of coronavirus disease (COVID-19) has rapidly spread globally and infected millions of people. The prevalence and prognostic impact of dysnatremia in COVID-19 is inconclusive. Therefore, we investigated the prevalence and outcome of dysnatremia in COVID-19.
The prospective, observational, cohort study included consecutive patients with clinical suspicion of COVID-19 triaged to a Swiss Emergency Department between March and July 2020.
Collected data included clinical, laboratory and disease severity scoring parameters on admission. COVID-19 cases were identified based on a positive nasopharyngeal swab test for SARS-CoV-2, patients with a negative swab test served as controls. The primary analysis was to assess the prognostic impact of dysnatremia on 30-day mortality using a cox proportional hazard model.
172 (17%) cases with COVID-19 and 849 (83%) controls were included. Patients with COVID-19 showed a higher prevalence of hyponatremia compared to controls (28.1% vs 17.5%, P < 0.001); while comparable for hypernatremia (2.9% vs 2.1%, P = 0.34). In COVID-19 but not in controls, hyponatremia was associated with a higher 30-day mortality (HR: 1.4, 95% CI: 1.10-16.62, P = 0.05). In both groups, hypernatremia on admission was associated with higher 30-day mortality (COVID-19 - HR: 11.5, 95% CI: 5.00-26.43, P < 0.001; controls - HR: 5.3, 95% CI: 1.60-17.64, P = 0.006). In both groups, hyponatremia and hypernatremia were significantly associated with adverse outcome, for example, intensive care unit admission, longer hospitalization and mechanical ventilation.
Our results underline the importance of dysnatremia as predictive marker in COVID-19. Treating physicians should be aware of appropriate treatment measures to be taken for patients with COVID-19 and dysnatremia.
冠状病毒病（COVID-19）的大流行在全球范围内迅速蔓延，感染了数百万人。COVID-19 中电解质紊乱的患病率和预后影响尚无定论。因此，我们调查了 COVID-19 中电解质紊乱的患病率和结果。
前瞻性、观察性队列研究纳入 2020 年 3 月至 7 月期间瑞士急诊分诊的具有 COVID-19 临床疑似症状的连续患者。
收集的数据包括入院时的临床、实验室和疾病严重程度评分参数。COVID-19 病例的确定基于鼻咽拭子 SARS-CoV-2 检测阳性，阴性拭子检测的患者作为对照。主要分析是使用 Cox 比例风险模型评估电解质紊乱对 30 天死亡率的预后影响。
纳入了 172 例（17%）COVID-19 患者和 849 例（83%）对照。与对照组相比，COVID-19 患者的低钠血症患病率更高（28.1%对 17.5%，P < 0.001）；而高钠血症的患病率相似（2.9%对 2.1%，P = 0.34）。在 COVID-19 中，但不在对照组中，低钠血症与较高的 30 天死亡率相关（HR：1.4，95%CI：1.10-16.62，P = 0.05）。在两组中，入院时的高钠血症与较高的 30 天死亡率相关（COVID-19 - HR：11.5，95%CI：5.00-26.43，P < 0.001；对照组 - HR：5.3，95%CI：1.60-17.64，P = 0.006）。在两组中，低钠血症和高钠血症均与不良结局显著相关，例如入住重症监护病房、住院时间延长和机械通气。
我们的结果强调了电解质紊乱作为 COVID-19 预测标志物的重要性。治疗医生应注意对 COVID-19 合并电解质紊乱患者采取适当的治疗措施。
