低钠血症对新型冠状病毒肺炎相关结局的影响：一项回顾性分析

Impact of Hyponatremia on COVID-19-Related Outcomes: A Retrospective Analysis.

作者信息

Piza Pedro Maciel de Toledo, de Freitas Victor Muniz, Aguiar-Brito Isabella, Calsolari-Oliveira Barbara Monique, Rangel Érika Bevilaqua

机构信息

Paulista School of Medicine, Federal University of São Paulo, São Paulo 04023-062, SP, Brazil.

Department of Medicine, Nephrology Division, Federal University of São Paulo, São Paulo 04038-031, SP, Brazil.

出版信息

Biomedicines. 2024 Sep 2;12(9):1997. doi: 10.3390/biomedicines12091997.

DOI:10.3390/biomedicines12091997

PMID:39335510

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11444129/

Abstract

BACKGROUND

Sodium disturbances are observed in one-third of patients with COVID-19 and result from multifaceted mechanisms. Notably, hyponatremia is associated with disease progression and mortality.

AIM

We aimed to analyze the impact of hyponatremia on COVID-19 outcomes and its correlation with clinical and laboratory parameters during the first wave.

METHODS

We evaluated the sodium levels of 558 patients with COVID-19 between 21 March 2020, and 31 July 2020, at a single center. We performed linear regression analyses to explore the correlation of sodium levels with COVID-19-related outcomes, demographic data, signs and symptoms, and laboratory parameters. Next, we conducted Pearson correlation analyses. A -value < 0.05 was considered significant.

RESULTS

Hyponatremia was found in 35.3% of hospitalized patients with COVID-19. This was associated with the need for intensive care transfer (B = -1.210, = 0.009) and invasive mechanical ventilation (B = -1.063, = 0.032). Hyponatremia was frequently found in oncologic patients ( = 0.002) and solid organ transplant recipients ( < 0.001). Sodium was positively associated with diastolic blood pressure ( = 0.041) and productive cough ( = 0.022) and negatively associated with dry cough ( = 0.032), anorexia ( = 0.004), and nausea/vomiting ( = 0.007). Regarding the correlation of sodium levels with other laboratory parameters, we observed a positive correlation with hematocrit ( = 0.011), lymphocytes ( = 0.010), pCO ( < 0.0001), bicarbonate ( = 0.0001), and base excess ( = 0.008) and a negative correlation with the neutrophil-to-lymphocyte ratio ( = 0.009), the platelet-to-lymphocyte ratio ( = 0.033), and arterial blood glucose ( = 0.016).

CONCLUSIONS

Hyponatremia is a risk factor for adverse outcomes in COVID-19 patients. It is associated with demographic data and clinical and laboratory parameters. Therefore, hyponatremia is an important tool for risk stratification in COVID-19 patients.

摘要

背景

在三分之一的新冠肺炎患者中观察到钠紊乱，其由多方面机制引起。值得注意的是，低钠血症与疾病进展和死亡率相关。

目的

我们旨在分析低钠血症对新冠肺炎预后的影响及其在疫情第一波期间与临床和实验室参数的相关性。

方法

我们评估了2020年3月21日至2020年7月31日期间在单一中心的558例新冠肺炎患者的钠水平。我们进行线性回归分析以探索钠水平与新冠肺炎相关预后、人口统计学数据、体征和症状以及实验室参数之间的相关性。接下来，我们进行Pearson相关性分析。P值<0.05被认为具有统计学意义。

结果

在住院的新冠肺炎患者中，35.3%存在低钠血症。这与需要转至重症监护病房（B = -1.210，P = 0.009）和有创机械通气（B = -1.063，P = 0.032）相关。低钠血症在肿瘤患者（P = 0.002）和实体器官移植受者中（P<0.001）较为常见。钠与舒张压（P = 0.041）和咳痰（P = 0.022）呈正相关，与干咳（P = 0.032）、厌食（P = 0.004）和恶心/呕吐（P = 0.007）呈负相关。关于钠水平与其他实验室参数的相关性，我们观察到与血细胞比容（P = 0.011）、淋巴细胞（P = 0.010）、二氧化碳分压（P<0.0001）、碳酸氢盐（P = 0.0001）和碱剩余（P = 0.008）呈正相关，与中性粒细胞与淋巴细胞比值（P = 0.009）、血小板与淋巴细胞比值（P = 0.033）和动脉血糖（P = 0.016）呈负相关。