Negative prognostic impact of electrolyte disorders in patients hospitalized for Covid-19 in a large multicenter
Simonetta Genovesi1,2, Giuseppe Regolisti3,4, Paola Rebora5
1School of Medicine and Surgery, Nephrology Clinic, Milano-Bicocca University, Milan, Italy. simonetta.genovesi@unimib.it.
Insights
Hospitalized COVID-19 patients with hyperkalemia or hypernatremia face higher in-hospital death risks. Hyponatremia also increases the likelihood of Intensive Care Unit admission, highlighting the prognostic value of electrolyte levels.
Area of Science:
- Internal Medicine
- Critical Care Medicine
- Infectious Diseases
Background:
- The prognostic significance of electrolyte imbalances in hospitalized COVID-19 patients remains incompletely understood.
- Early identification of high-risk patients is crucial for effective management.
Purpose of the Study:
- To investigate the association between serum potassium and sodium levels and clinical outcomes in hospitalized COVID-19 patients.
- To determine if electrolyte disorders at admission can predict adverse events such as in-hospital death or ICU admission.
Main Methods:
- A cohort study included 3,418 adult COVID-19 patients hospitalized in Northern Italy (January 2020 - May 2021).
- Serum potassium and sodium levels were measured within 3 days of admission.
- Cause-specific Cox proportional-hazards regression models analyzed the relationship between electrolyte levels (categorical and continuous) and outcomes.
Main Results:
- Hyperkalemia and hypernatremia were significantly associated with increased in-hospital mortality.
- Elevated serum potassium and sodium above median values also correlated with higher death rates.
- Hyponatremia was linked to a greater risk of Intensive Care Unit admission, but not in-hospital death.
Conclusions:
- Electrolyte disturbances at hospital admission are potential early indicators of adverse outcomes in COVID-19 patients.
- Monitoring potassium and sodium levels may aid in risk stratification and timely clinical intervention.
Background:
The prognostic impact of electrolyte disorders in hospitalized COVID-19 patients is unclear.
Methods:
The study included all adult patients hospitalized for COVID-19 in four hospitals in Northern Italy between January 2020 and May 2021 with at least one serum potassium and sodium measurement performed within 3 days since admission. Primary outcome was in-hospital death; secondary outcome was Intensive Care Unit (ICU) admission. A cause-specific Cox proportional-hazards regression model was used for investigating the association between potassium and sodium (as either categorical or continuous variables) and mortality or admission to ICU.
Results:
Analyses included 3,418 adult hospitalized COVID-19 patients. At multivariable analysis, both hyperkalemia (Hazard Ratio, [HR] 1.833, 95% Confidence Interval [CI] 1.371-2.450) and sK above the median (K 5.1 vs 4.1 mmol/L: HR 1.523, 95% CI 1.295-1.798), and hypernatremia (HR 2.313, 95%CI 1.772-3.018) and sNa above the median (Na 149 vs 139 mmol/L: HR 1.442, 95% CI 1.234-1.686), were associated with in-hospital death, whereas hypokalemia and hyponatremia were not. Hyponatremia was associated with increased hazard of ICU admission (HR 1.884, 95%CI 1.389-2.556).
Conclusions:
Electrolyte disorders detected at hospital admission may allow early identification of COVID-19 patients at increased risk of adverse outcomes.
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