Chan Gordon Chun Kau, Wong Chun Ka, So Benjamin Y F, Ng Jack Kit Chung, Lui Grace Chung Yan, Szeto Cheuk Chun, Hung Ivan Fan Ngai, Tse Hung Fat, Tang Sydney C W, Chan Tak Mao, Chow Kai Ming, Yap Desmond Y H
Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Front Med (Lausanne). 2023 Jan 11;9:1096165. doi: 10.3389/fmed.2022.1096165. eCollection 2022.
Hyponatremia is common in COVID-19, but its epidemiology and impact on clinical outcomes in relation to different variants, especially the Omicron variant, requires further clarification.
This was a territory-wide retrospective study to investigate the epidemiology and outcomes of COVID-19 patients with hyponatremia from January 1, 2020 to March 31, 2022 in Hong Kong. The primary outcome was 30-day mortality of patients with COVID-19 and hyponatremia at presentation. Secondary outcomes included rate of hospitalization, intensive care unit (ICU) hospitalization, overall duration of hospitalization, and duration of ICU hospitalization.
A total of 53,415 COVID-19 patients were included for analysis, of which 14,545 (27.2%) had hyponatremia at presentation. 9813 (67.5%), 2821 (19.4%), and 1911 (13.1%) had mild (130 to <135 mmol/L), moderate (125 to <130 mmol/L), and severe hyponatremia (<125 mmol/L) at presentation respectively. Age, male sex, diabetes, active malignancy, white cell count, serum creatinine, hypoalbuminemia, C-reactive protein, and viral loads were independent predictors for hyponatremia in COVID-19 patients ( < 0.001, for all). Hyponatremic patients had increased 30-day mortality (9.7 vs. 5.7%, < 0.001), prolonged hospitalization (11.9 ± 15.1 days vs. 11.5 ± 12.1 days, < 0.001), and more ICU admissions (7.0% vs. 3.3%, < 0.001). Patients diagnosed during the "fifth wave" Omicron BA.2 outbreak had 2.29-fold risk (95% CI 2.02-2.59, < 0.001) of presenting with hyponatremia compared to other waves.
Hyponatremia is common among COVID-19 patients, and may serve as a prognostic indicator for unfavorable outcomes and increased healthcare utilization in the evolving COVID-19 outbreak.
低钠血症在新型冠状病毒肺炎（COVID-19）中很常见，但其流行病学以及与不同变体（尤其是奥密克戎变体）相关的临床结局影响，需要进一步阐明。
这是一项全港范围的回顾性研究，旨在调查2020年1月1日至2022年3月31日香港COVID-19合并低钠血症患者的流行病学及结局。主要结局是COVID-19合并低钠血症患者就诊时的30天死亡率。次要结局包括住院率、重症监护病房（ICU）住院率、总住院时长及ICU住院时长。
共纳入53415例COVID-19患者进行分析，其中14545例（27.2%）就诊时存在低钠血症。就诊时分别有9813例（67.5%）、2821例（19.4%）和1911例（13.1%）患有轻度（130至<135 mmol/L）、中度（125至<130 mmol/L）和重度低钠血症（<125 mmol/L）。年龄、男性、糖尿病、活动性恶性肿瘤、白细胞计数、血清肌酐、低白蛋白血症、C反应蛋白及病毒载量是COVID-19患者低钠血症的独立预测因素（均P<0.001）。低钠血症患者30天死亡率增加（9.7%对5.7%，P<0.001），住院时间延长（11.9±15.1天对11.5±12.1天，P<0.001），且入住ICU的比例更高（7.0%对3.3%，P<0.001）。与其他波次相比，在“第五波”奥密克戎BA.2疫情期间确诊的患者出现低钠血症的风险高2.29倍（95%CI 2.02-2.59，P<0.001）。
低钠血症在COVID-19患者中很常见，可能是不断演变的COVID-19疫情中不良结局和医疗资源利用增加的预后指标。
