Diane Liu1,2, Wenzhu Mowrey3, Molly Fisher4, Abby Basalely2,5, John McCarthy6, Neelja Kumar4, Jyotsana Thakkar4, Yorg Azzi4, Maureen Brogan4, Ladan Golestaneh4, Kimberly J Reidy2, Wei Chen4,6,7. 1. Division of Pediatric Nephrology, Weill Cornell Medical Center, New York, New York. 2. Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York. 3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. 4. Division of Nephrology, Montefiore Medical Center, Bronx, New York. 5. Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, New York. 6. Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York. 7. Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Abstract
Background: In patients without COVID-19, dysnatremia is associated with mortality. These relationships are not well established in patients with COVID-19. We tested the hypotheses that patients with COVID-19 were more likely to have dysnatremia than those without COVID-19 and that, among those with COVID-19, dysnatremia is associated with mortality. Methods: We conducted a retrospective observational study of patients admitted to a tertiary care center in the Bronx, New York, during the COVID-19 surge from March 11 to April 26, 2020. Using multinomial logistic regression models, we compared the prevalence of hypernatremia (serum sodium ≥150 mEq/L) and hyponatremia (serum sodium <130 mEq/L) on admission between patients with and without COVID-19. Among patients with COVID-19, we used Cox proportional hazards models to examine the association of dysnatremia with mortality. Results: Compared with those without COVID-19 (n=1265), patients with COVID-19 (n=3345) had a higher prevalence of hypernatremia (7% versus 4%, P<0.001) and hyponatremia (7% versus 6%, P=0.04). In adjusted models, COVID-19-positive patients had a higher likelihood of having hypernatremia (adjusted odds ratio=1.87, 95% CI, 1.3 to 2.57, P=0.001) compared with COVID-19-negative patients, whereas the association between hyponatremia and COVID-19 status was no longer significant (P=0.06). Among patients with COVID-19, 775 (23%) died after a median follow-up of 17 days (IQR 7-27 days). Among nonsurvivors, 15% had hypernatremia and 8% had hyponatremia on admission. Hypernatremia was associated with a higher risk of mortality (adjusted hazard ratio=1.28, 95% CI, 1.01 to 1.63, P=0.04) compared with patients with eunatremia. Conclusions: In patients hospitalized during the spring 2020 COVID-19 surge, COVID-19 status was associated with hypernatremia on admission. Among patients with COVID-19, hypernatremia was associated with higher mortality. Hypernatremia may be a potential prognostic marker for mortality in COVID-19 patients.
Background: In patients without COVID-19, dysnatremia is associated with mortality. These relationships are not well established in patients with COVID-19. We tested the hypotheses that patients with COVID-19 were more likely to have dysnatremia than those without COVID-19 and that, among those with COVID-19, dysnatremia is associated with mortality. Methods: We conducted a retrospective observational study of patients admitted to a tertiary care center in the Bronx, New York, during the COVID-19 surge from March 11 to April 26, 2020. Using multinomial logistic regression models, we compared the prevalence of hypernatremia (serum sodium ≥150 mEq/L) and hyponatremia (serum sodium <130 mEq/L) on admission between patients with and without COVID-19. Among patients with COVID-19, we used Cox proportional hazards models to examine the association of dysnatremia with mortality. Results: Compared with those without COVID-19 (n=1265), patients with COVID-19 (n=3345) had a higher prevalence of hypernatremia (7% versus 4%, P<0.001) and hyponatremia (7% versus 6%, P=0.04). In adjusted models, COVID-19-positive patients had a higher likelihood of having hypernatremia (adjusted odds ratio=1.87, 95% CI, 1.3 to 2.57, P=0.001) compared with COVID-19-negative patients, whereas the association between hyponatremia and COVID-19 status was no longer significant (P=0.06). Among patients with COVID-19, 775 (23%) died after a median follow-up of 17 days (IQR 7-27 days). Among nonsurvivors, 15% had hypernatremia and 8% had hyponatremia on admission. Hypernatremia was associated with a higher risk of mortality (adjusted hazard ratio=1.28, 95% CI, 1.01 to 1.63, P=0.04) compared with patients with eunatremia. Conclusions: In patients hospitalized during the spring 2020 COVID-19 surge, COVID-19 status was associated with hypernatremia on admission. Among patients with COVID-19, hypernatremia was associated with higher mortality. Hypernatremia may be a potential prognostic marker for mortality in COVID-19 patients.
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