Habas Elmukhtar, Abugrara Said Abdussalam, Faidh Ramzee Ahmed, Ghazouani Hafedh, Fino Areen, Abu Khattab Mohamad A, Al Masalamani Muna S, Prabhakaran Nair Arun
Internal Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar E-mail:
Department of Radiology, Al-Rumailah Hospital, Doha, Qatar.
Qatar Med J. 2022 Aug 5;2022(3):34. doi: 10.5339/qmj.2022.34. eCollection 2022.
The World Health Organization declared the coronavirus disease-2019 (COVID-19) a pandemic in December 2019. COVID-19 can affect most organs of the body but predominantly affects the lungs. Chest infection is associated with hyponatremia primarily due to inappropriate ectopic secretion of antidiuretic hormone. We conducted a six-month retrospective observational study to evaluate the relationship between chest X-ray (CXR) radiological findings and serum sodium levels. Our secondary goal was to assess the relationship between CXR findings and patient outcomes.
To assess the relationship between the initial CXR findings, hyponatremia severity, and outcome in COVID-19 infected patients.
We conducted a retrospective review of CXR findings of COVID-19 patients aged > 18 years. The patients were healthy and had no history of hyponatremia before COVID-19 infection. All recruited patients were admitted to one of four hospitals in Qatar (Hazm Mebaireek General Hospital, Communicable Disease Center, and all affiliated quarantine centers managed under the Communicable Disease Centre, Mesaieed Hospital, and Ras Laffan Hospital) between March and June 2020. We excluded patients with factors that contributed to hyponatremia. Three score grades were established to describe the CXR findings. Patients were divided into three groups by the principal researcher according to their serum sodium levels. A radiologist evaluated the CXR findings with the patient and group information obscured. The principal researcher collected the X-ray scores for analysis with the serum sodium levels. We used SPSS for Windows, Version 15.0. (SPSS Inc., Chicago, IL, USA) and STATA Package Version 12.0 (StataCorp, College Station, TX, USA) to analyze the data. A -value ≤ 0.05 was considered significant.
A total of 414 CXR patients with COVID-19 were recruited; 275 patients had hyponatremia and 139 had normal sodium levels and were used as the control group. Patients with normal serum sodium and hyponatremia were classified into three categories based on the CXR findings. Grade 0 (95), Grade 1 (43), and Grade 2 (137) hyponatremic patients were reported. The mean sodium levels were 133.6, 131.3, and 127.2 mmol/L for Grades 0, 1, and 2, respectively ( < 0.001). More than 95% of the patients who developed hyponatremia were >30 years. Moderate and severe hyponatremia was more prevalent in patients with Grade 1 or Grade 2 CXR findings and were >30 years.
Serum sodium levels in COVID-19 patients correlated well with the severity of the CXR findings observed at the early disease stage. Furthermore, simple CXR scores can be used to identify COVID-19 patients at a higher risk of hyponatremia, length of hospital stay, medical care support type, and mortality.
世界卫生组织于2019年12月宣布冠状病毒病2019（COVID-19）为大流行病。COVID-19可影响身体的大多数器官，但主要影响肺部。胸部感染与低钠血症相关，主要原因是抗利尿激素不适当的异位分泌。我们进行了一项为期六个月的回顾性观察研究，以评估胸部X线（CXR）影像学表现与血清钠水平之间的关系。我们的次要目标是评估CXR表现与患者预后之间的关系。
评估COVID-19感染患者的初始CXR表现、低钠血症严重程度和预后之间的关系。
我们对年龄大于18岁的COVID-19患者的CXR表现进行了回顾性研究。这些患者在感染COVID-19之前身体健康，无低钠血症病史。2020年3月至6月期间，所有招募的患者均入住卡塔尔的四家医院之一（哈兹姆·梅贝里克综合医院、传染病中心以及在传染病中心管理下的所有附属检疫中心、迈赛义德医院和拉斯拉凡医院）。我们排除了导致低钠血症的因素的患者。建立了三个评分等级来描述CXR表现。主要研究者根据患者的血清钠水平将患者分为三组。一名放射科医生在不知道患者和分组信息的情况下评估CXR表现。主要研究者收集X线评分以与血清钠水平进行分析。我们使用Windows版SPSS 15.0（美国伊利诺伊州芝加哥市SPSS公司）和STATA软件包12.0版（美国得克萨斯州大学站市StataCorp公司）来分析数据。P值≤0.05被认为具有统计学意义。
共招募了414例COVID-19的CXR患者；275例患者有低钠血症，139例钠水平正常，作为对照组。根据CXR表现，血清钠正常和低钠血症患者分为三类。报告了0级（95例）、1级（43例）和2级（137例）低钠血症患者。0级、1级和2级的平均钠水平分别为133.6、131.3和127.2 mmol/L（P<0.001）。发生低钠血症的患者中超过95%年龄大于30岁。中度和重度低钠血症在CXR表现为1级或2级且年龄大于30岁的患者中更为普遍。
COVID-19患者的血清钠水平与疾病早期观察到的CXR表现严重程度密切相关。此外，简单的CXR评分可用于识别发生低钠血症、住院时间、医疗支持类型和死亡率风险较高的COVID-19患者。
