Hyponatremia, Inflammation at Admission, and Mortality in Hospitalized COVID-19 Patients: A Prospective Cohort Study

Background: Systemic inflammation has been associated with severe coronavirus disease 2019 (COVID-19) disease and mortality. Hyponatremia can result from inflammation due to non-osmotic stimuli for vasopressin production.Methods: We prospectively studied 799 patients hospitalized with COVID-19 betwe...

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Autores principales:	Juan Carlos Ayus, Armando Luis Negri, Michael L. Moritz, Kyung Min Lee, Daniel Caputo, Maria Elena Borda, Alan S. Go, Carlos Eghi
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	hyponatremia COVID-19 mortality inflammation C-reactive protein Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/01a18c154b7b4b73bda3f77979256950
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spelling	oai:doaj.org-article:01a18c154b7b4b73bda3f779792569502021-12-02T07:17:09ZHyponatremia, Inflammation at Admission, and Mortality in Hospitalized COVID-19 Patients: A Prospective Cohort Study2296-858X10.3389/fmed.2021.748364https://doaj.org/article/01a18c154b7b4b73bda3f779792569502021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.748364/fullhttps://doaj.org/toc/2296-858XBackground: Systemic inflammation has been associated with severe coronavirus disease 2019 (COVID-19) disease and mortality. Hyponatremia can result from inflammation due to non-osmotic stimuli for vasopressin production.Methods: We prospectively studied 799 patients hospitalized with COVID-19 between March 7 and November 7, 2020, at Hospital Posadas in Buenos Aires, Argentina in order to evaluate the association between hyponatremia, inflammation, and its impact on clinical outcomes. Admission biochemistries, high-sensitivity C-reactive protein (hsCRP), ferritin, patient demographics, and outcome data were recorded. Outcomes (within 30 days after symptoms) evaluated included ICU admission, mechanical ventilation, dialysis-requiring acute kidney injury (AKI), and in-hospital mortality. Length of hospital stay (in days) were evaluated using comprehensive data from the EHR.Results: Hyponatremia (median Na = 133 mmol/L) was present on admission in 366 (45.8%). Hyponatremic patients had higher hsCRP (median 10.3 [IR 4.8–18.4] mg/dl vs. 6.6 [IR 1.6–14.0] mg/dl, p < 0.01) and ferritin levels (median 649 [IQR 492–1,168] ng/dl vs. 393 [IQR 156–1,440] ng/dl, p = 0.02) than normonatremic patients. Hyponatremia was associated with higher odds of an abnormal hsCRP (unadjusted OR 5.03, 95%CI: 2.52–10.03), and remained significant after adjustment for potential confounders (adjusted OR 4.70 [95%CI: 2.33–9.49], p < 0.01). Hyponatremic patients had increased mortality on unadjusted (HR 3.05, 95%CI: 2.14–4.34) and adjusted (HR 2.76, 95%CI:1.88–4.06) in Cox proportional hazard models. Crude 30-day survival was lower for patients with hyponatremia at admission (mean [SD] survival 22.1 [0.70] days) compared with patients who were normonatremic (mean [SD] survival 27.2 [0.40] days, p < 0.01).Conclusion: Mild hyponatremia on admission is common, is associated with systemic inflammation and is an independent risk factor for hospital mortality.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT04493268.Juan Carlos AyusArmando Luis NegriMichael L. MoritzMichael L. MoritzKyung Min LeeDaniel CaputoMaria Elena BordaAlan S. GoAlan S. GoAlan S. GoAlan S. GoCarlos EghiFrontiers Media S.A.articlehyponatremiaCOVID-19mortalityinflammationC-reactive proteinMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	hyponatremia COVID-19 mortality inflammation C-reactive protein Medicine (General) R5-920
spellingShingle	hyponatremia COVID-19 mortality inflammation C-reactive protein Medicine (General) R5-920 Juan Carlos Ayus Armando Luis Negri Michael L. Moritz Michael L. Moritz Kyung Min Lee Daniel Caputo Maria Elena Borda Alan S. Go Alan S. Go Alan S. Go Alan S. Go Carlos Eghi Hyponatremia, Inflammation at Admission, and Mortality in Hospitalized COVID-19 Patients: A Prospective Cohort Study
description	Background: Systemic inflammation has been associated with severe coronavirus disease 2019 (COVID-19) disease and mortality. Hyponatremia can result from inflammation due to non-osmotic stimuli for vasopressin production.Methods: We prospectively studied 799 patients hospitalized with COVID-19 between March 7 and November 7, 2020, at Hospital Posadas in Buenos Aires, Argentina in order to evaluate the association between hyponatremia, inflammation, and its impact on clinical outcomes. Admission biochemistries, high-sensitivity C-reactive protein (hsCRP), ferritin, patient demographics, and outcome data were recorded. Outcomes (within 30 days after symptoms) evaluated included ICU admission, mechanical ventilation, dialysis-requiring acute kidney injury (AKI), and in-hospital mortality. Length of hospital stay (in days) were evaluated using comprehensive data from the EHR.Results: Hyponatremia (median Na = 133 mmol/L) was present on admission in 366 (45.8%). Hyponatremic patients had higher hsCRP (median 10.3 [IR 4.8–18.4] mg/dl vs. 6.6 [IR 1.6–14.0] mg/dl, p < 0.01) and ferritin levels (median 649 [IQR 492–1,168] ng/dl vs. 393 [IQR 156–1,440] ng/dl, p = 0.02) than normonatremic patients. Hyponatremia was associated with higher odds of an abnormal hsCRP (unadjusted OR 5.03, 95%CI: 2.52–10.03), and remained significant after adjustment for potential confounders (adjusted OR 4.70 [95%CI: 2.33–9.49], p < 0.01). Hyponatremic patients had increased mortality on unadjusted (HR 3.05, 95%CI: 2.14–4.34) and adjusted (HR 2.76, 95%CI:1.88–4.06) in Cox proportional hazard models. Crude 30-day survival was lower for patients with hyponatremia at admission (mean [SD] survival 22.1 [0.70] days) compared with patients who were normonatremic (mean [SD] survival 27.2 [0.40] days, p < 0.01).Conclusion: Mild hyponatremia on admission is common, is associated with systemic inflammation and is an independent risk factor for hospital mortality.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT04493268.
format	article
author	Juan Carlos Ayus Armando Luis Negri Michael L. Moritz Michael L. Moritz Kyung Min Lee Daniel Caputo Maria Elena Borda Alan S. Go Alan S. Go Alan S. Go Alan S. Go Carlos Eghi
author_facet	Juan Carlos Ayus Armando Luis Negri Michael L. Moritz Michael L. Moritz Kyung Min Lee Daniel Caputo Maria Elena Borda Alan S. Go Alan S. Go Alan S. Go Alan S. Go Carlos Eghi
author_sort	Juan Carlos Ayus
title	Hyponatremia, Inflammation at Admission, and Mortality in Hospitalized COVID-19 Patients: A Prospective Cohort Study
title_short	Hyponatremia, Inflammation at Admission, and Mortality in Hospitalized COVID-19 Patients: A Prospective Cohort Study
title_full	Hyponatremia, Inflammation at Admission, and Mortality in Hospitalized COVID-19 Patients: A Prospective Cohort Study
title_fullStr	Hyponatremia, Inflammation at Admission, and Mortality in Hospitalized COVID-19 Patients: A Prospective Cohort Study
title_full_unstemmed	Hyponatremia, Inflammation at Admission, and Mortality in Hospitalized COVID-19 Patients: A Prospective Cohort Study
title_sort	hyponatremia, inflammation at admission, and mortality in hospitalized covid-19 patients: a prospective cohort study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/01a18c154b7b4b73bda3f77979256950
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Hyponatremia, Inflammation at Admission, and Mortality in Hospitalized COVID-19 Patients: A Prospective Cohort Study

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