What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals

ObjectivesTo evaluate the relationship among dysnatraemia at hospital presentation and duration of admission, risk of intensive care unit (ICU) admission and all-cause mortality and to assess the underlying pathophysiological mechanism of hyponatraemia in patients with COVID-19. Our hypothesis is th...

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Published in:	BMJ open Vol. 13; no. 11; p. e075232
Main Authors:	de Haan, Lianne, ten Wolde, Marije, Beudel, Martijn, Olde Engberink, Rik H G, Appelman, Brent, Gritters van den Oever, Niels C, Paternotte, Nienke, van den Bergh, Joop P, Moeniralam, Hazra, Bokhizzou, Neyma, Douma, Renee, Douma, Renée, Brinkman, Kees, van den Oever, Niels Gritters, Bergh, Joop van den, Leavis, Helen, Piña-Fuentes, Dan, Thomas, Rajat, Hu, Shi, Herter, Willem, Wolfers, Marije, Schinkel, Michiel, Kuij, Sander de, Dormans, Tom, Noordzij, Sophie, Bosch, Sibbeliene van den, Verhoef, Benthe, Methorst, Michele, Darwesh, Shahan, Nasim, Gulsum, Boer, Lars de, Nagel, Myrthe, Koenis, Maud, Bijlsma, Agnetha, Balvers, Britt, Jongh, Jelle de, Emanuel, Maira, Aynaou, Nisrine, Cinar, Alanar, Roosen, Jesse, Leliveld, Asabi, Ruijter, Dana, Rosenberg, Neeltje, Woutman, Djoeke, Vermeulen, Tom, de Joode, Sam, Ludden, Thomas, Varan, Ozgu, Pinto, Soesja, Sluis, Sientje, Kuiper, Bibi, Putten, Tim van der, Bosje, Dominique, Sinyangwe, Mahunda, Kruif, Koen, Haan, Lianne de, Heijer, Miriam den, Kruijf, Koen de, Hofhuis, Sam, Telting, Gwendolyn, Lei, Susan van der, Paassen, Pien van, Opschoor, Krijna, Jiwa, Florine, Gooyer, Peter de, Vrijdag, Jan, Gelder, Stans van, Adang, Estelle, Maren, Maud van, Koop, Isabel, Sanders, Bart, Trommelen, Dax, Smeets, Fleur, Hendrikx, Vivian, Rooij, Ilona van, Brans, Evelien, Slot, Karin, Kok, Wilma, Harmsen, Lieke, Raafs, Anne, Smaal, Anne, Pop, Bibiane, Verkouteren, Babette, Vrij, Casper, Willik, Daphne van der, Hubers, Deborah, Lems, Esther, Pieters, Imogene, Sijben, Laura, Peeters, Maikel, Blok-Hoos, Marije, Ketels, Marjolein, Henkens, Michiel, Hoogt, Patrick de, Houben, Rik, Goldhoorn, Robert-Jan, Hinsenveld, Wouter
Format:	Journal Article
Language:	English
Published:	London British Medical Journal Publishing Group 14-11-2023 BMJ Publishing Group LTD BMJ Publishing Group
Subjects:	Clinical outcomes COVID-19 Creatinine Cytokines Etiology Hospitals Hypernatremia Hypertension Hyponatremia Infections Infectious diseases internal medicine Kidney diseases Kruskal-Wallis test Mortality Observational studies Pandemics Patients Severe acute respiratory syndrome coronavirus 2 Sodium Survival analysis Tropical diseases Variance analysis Ventilators
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Summary:	ObjectivesTo evaluate the relationship among dysnatraemia at hospital presentation and duration of admission, risk of intensive care unit (ICU) admission and all-cause mortality and to assess the underlying pathophysiological mechanism of hyponatraemia in patients with COVID-19. Our hypothesis is that both hyponatraemia and hypernatraemia at presentation are associated with adverse outcomes.DesignObservational study.SettingSecondary care; 11 Dutch hospitals (2 university and 9 general hospitals).ParticipantsAn analysis was performed within the retrospective multicentre cohort study COVIDPredict. 7811 patients were included (60% men, 40% women) between 24 February 2020 and 9 August 2022. Patients who were ≥18 years with PCR-confirmed COVID-19 or CT with COVID-19 reporting and data system score≥4 and alternative diagnosis were included. Patients were excluded when serum sodium levels at presentation were not registered in the database or when they had been transferred from another participating hospital.Outcome measuresWe studied demographics, medical history, symptoms and outcomes. Patients were stratified according to serum sodium concentration and urinary sodium excretion.ResultsHyponatraemia was present in 2677 (34.2%) patients and hypernatraemia in 126 (1.6%) patients. Patients with hyponatraemia presented more frequently with diarrhoea, lower blood pressure and tachycardia. Hyponatraemia was, despite a higher risk for ICU admission (OR 1.27 (1.11–1.46; p<0.001)), not associated with mortality or the risk for intubation. Patients with hypernatraemia had higher mortality rates (OR 2.25 (1.49–3.41; p<0.001)) and were at risk for ICU admission (OR 2.89 (1.83–4.58)) and intubation (OR 2.95 (1.83–4.74)).ConclusionsHypernatraemia at presentation was associated with adverse outcomes in patients with COVID-19. Hypovolaemic hyponatraemia was found to be the most common aetiology of hyponatraemia. Hyponatraemia of unknown aetiology was associated with a higher risk for ICU admission and intubation and longer duration of admission.
Bibliography:	Original research ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	2044-6055 2044-6055
DOI:	10.1136/bmjopen-2023-075232