Hyponatremia as a Predictive Marker of Mortality in Hospitalized COVID- 19 Patients: A Healthcare System Analysis
Recommended Citation
Singh H, Bachour C, Metcalf D, Luthra K, and Kak V. Hyponatremia as a Predictive Marker of Mortality in Hospitalized COVID- 19 Patients: A Healthcare System Analysis. Am J Respir Crit Care Med 2024; 209.
Document Type
Conference Proceeding
Publication Date
5-2024
Publication Title
Am J Respir Crit Care Med
Abstract
Rationale: There is documented evidence of the association between hyponatremia and mortality in hospitalized patients, including patients admitted with coronavirus disease-2019 (COVID-19) pneumonia. One of the proposed mechanisms of hyponatremia in COVID-19 is the syndrome of inappropriate antidiuretic hormone (SIADH) due to circulating cytokines such as IL-6. These cytokines are proposed to be associated with lung inflammation and correlate with respiratory failure and in-hospital mortality. Immunomodulators, tocilizumab and baricitinib, acting against the cytokine response, are known to reduce mortality in hospitalized COVID-19 patients. This study was undertaken to associate the severity of hyponatremia with in-hospital mortality in patients admitted with COVID-19 in multiple hospitals over a single health system network.
Methods: After obtaining appropriate institutional review board (IRB) approval, a retrospective chart review was conducted from 03/01/2020 to 06/01/2021, which included all admitted patients with positive COVID-19 polymerase chain reaction tests at the time of admission. Individuals less than 18 years of age, incarcerated, and pregnant patients were excluded. Performance analytics and improvement (PAI) tool was used to extract patient records. The patients were categorized based on their admission sodium values into the following groups: normal sodium (>=136 mEq/L), mild hyponatremia (131 to 135 mEq/L), moderate hyponatremia (121 to 130 mEq/L), and severe hyponatremia (<=120 mEq/L). Primary and secondary outcomes calculated were hospital mortality and length of stay. IBM SPSS software was used to perform the data analysis. Chi-square tests and ANOVA tests were run to evaluate these outcomes.
Results: Data for 2561 patients was extracted using the above method. 14 cases with severe hyponatremia were not included because of the small case count and its minute impact on the analysis and the interpretation of the results. Hence, 2547 patients were analyzed in this study. The percentage of in-hospital mortality in patients with normal sodium, mild hyponatremia, and moderate hyponatremia was found to be 8.7% (109/1260), 8.9% (84/945), and 15.8% (54/342) respectively; with Chi-Square p-value of <0.001 comparing mortality between the moderate hyponatremia group with the rest of the individual groups. Hospital length of stay of groups with normal sodium, mild hyponatremia, and moderate hyponatremia was 8.03, 7.99, and 9.44 days, respectively, with ANOVA F-Test P-value of 0.012.
Conclusion: Admission hyponatremia of <130 mEq/L in COVID-19 patients is associated with a higher in-hospital mortality. Hence, admission sodium level may be used as a prognosticating factor and possible variable in the future COVID-19 treatment trials.
Volume
209
