电解质失衡对住院 COVID-19 患者死亡率和晚期急性肾损伤的影响。

Effect of Electrolyte Imbalance on Mortality and Late Acute Kidney Injury in Hospitalized COVID-19 Patients.

机构信息

Safety Promotion and Injury Prevention Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.

出版信息

Iran J Kidney Dis. 2022 Jul;16(4):228-237.

PMID:35962637

Abstract

INTRODUCTION

As a multisystem illness, Coronavirus disease 2019 (COVID-19) can damage different organs. This study investigated the effect of electrolyte imbalance (EI), with or without concomitant renal dysfunction, on the prognosis of COVID-19 in hospitalized patients.

METHODS

We evaluated 499 hospitalized patients with confirmed COVID-19, without a history of chronic kidney disease. The patients' demographic data, laboratory values, and outcomes were retrospectively collected from the hospital information system. Serumelectrolytes including sodium, potassium, magnesium, calcium, and phosphorus abnormalities were analyzed on admission and during the hospitalization period. The outcomes of this study were the occurrence of acute kidney injury (AKI) after the first week of hospitalization and in-hospital mortality rate. Multivariate analyses were carried out to obtain the independent risk of each EI on mortality, by adjusting for age, gender, and AKI occurrence.

RESULTS

Among the 499 COVID-19 patients (60.9% male), AKI occurred in 168 (33.7%) and mortality in 92 (18.4%) cases. Hypocalcemia (38%) and hyponatremia (22.6%) were the most prevalent EIs, and all EIs were more common in the AKI group than in the non-AKI group. Hyponatremia (Adjusted Odds ratio [AOR] = 2.34, 95% CI: 1.30 to 4.18), hypernatremia (AOR = 8.52, 95% CI: 1.95 to 37.32), and hyperkalemia (AOR = 4.63, 95% CI: 1.65 to 13) on admission were associated with poor prognosis. Moreover, hyponatremia (AOR = 3.02, 95% CI: 1.28 to 7.15) and hyperphosphatemia (AOR = 5.12, 95% CI: 1.24 to 21.09) on admission were associated with late AKI occurrence.

CONCLUSION

This study highlights the role of hyponatremia, hypernatremia, hyperkalemia, and hyperphosphatemia in poor prognosis of COVID-19. According to the independent effect of EI on late AKI and mortality, we recommend physicians to raise awareness to closely monitor and correct EI during hospitalization. DOI: 10.52547/ijkd.6904.

摘要

简介

作为一种多系统疾病，2019 年冠状病毒病（COVID-19）可损害不同的器官。本研究旨在探讨电解质失衡（EI）对住院 COVID-19 患者预后的影响，无论是否同时伴有肾功能障碍。

方法

我们评估了 499 例确诊为 COVID-19 的住院患者，且无慢性肾病病史。通过医院信息系统回顾性收集患者的人口统计学数据、实验室值和预后情况。入院时和住院期间分析血清电解质（包括钠、钾、镁、钙和磷）异常。本研究的结局为住院后第一周内发生急性肾损伤（AKI）和院内死亡率。通过调整年龄、性别和 AKI 发生情况，对每个 EI 对死亡率的独立风险进行多变量分析。

结果

在 499 例 COVID-19 患者（60.9%为男性）中，168 例（33.7%）发生 AKI，92 例（18.4%）死亡。低钙血症（38%）和低钠血症（22.6%）是最常见的 EI，且所有 EI 在 AKI 组比非 AKI 组更常见。入院时低钠血症（调整优势比 [AOR] = 2.34，95%CI：1.30 至 4.18）、高钠血症（AOR = 8.52，95%CI：1.95 至 37.32）和高钾血症（AOR = 4.63，95%CI：1.65 至 13）与不良预后相关。此外，入院时低钠血症（AOR = 3.02，95%CI：1.28 至 7.15）和高磷血症（AOR = 5.12，95%CI：1.24 至 21.09）与晚期 AKI 的发生相关。