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Hypernatremia in Critically Ill COVID-19 Patients: Is it a manifestation of COVID-19 or acquired in the ICU?

Yıl 2023, Cilt: 9 Sayı: 1, 135 - 146, 28.02.2023
https://doi.org/10.19127/mbsjohs.1225466

Öz

Objective: It has been noted that COVID-19 patients experienced electrolyte problems more frequently, and these disturbances were linked to unfavorable results. The purpose of this study was to investigate the incidence and consequences of hypernatremia in severely ill COVID-19 patients receiving intensive care (ICU).

Methods: Retrospective data analysis was done on COVID-19 patients who were admitted to ICUs over a six-month period at two centers.

Results: Data from 270 patients were collected in total. 138 (51%) patients developed hypernatremia (Na >145 mmol/l) during ICU stay. Hypernatremia was observed to be more in older or ventilated patients, whereas less in patients with chronic kidney disease. However, in patients with and without hypernatremia, unfavorable outcomes like length of stay (LOS) or mortality were comparable. Frequency of hypertension, septic shock as well as SOFA score, and serum BUN levels were significantly higher in moderate to severe hypernatremic (Na ≥150 mmol/l) vs mild hypernatremic (Na=146-149 mmol/l) group. Moderate to severe hypernatremia had worse prognosis than the mild group: ICU LOS (12 vs 9-day, p=0.033), ICU mortality (86% vs 61%, p=0.001 and 28-day mortality (89% vs 68%, p=0.004). Elevated serum BUN levels and moderate to severe hypernatremia were independent predictors of both ICU and 28-day mortality.

Conclusion: Critically ill COVID-19 patients experienced hypernatremia more frequently than expected, suggesting that hypernatremia may be a manifestation of systemic involvement of COVID-19 rather than iatrogenic. Patients with and without hypernatremia were found to have similar outcomes.

Kaynakça

  • 1. Palevsky PM, Bhagrath R, Greenberg A. Hypernatremia in hospitalized patients. Ann Intern Med 1996;124:197- 203.
  • 2. Lindner G, Funk GC, Schwarz C, et al. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis 2007; 50:952-7.
  • 3. Lindner G, Funk GC. Hypernatremia in critically ill patients. J Crit Care 2013;28(2):216.e11-216.e2.16E20.
  • 4. Zimmer MA, Zink AK, Weisser CW, Vogt U, Michelsen A, Priebe HJ, et al. Hypernatremia-A Manifestation of COVID-19: A Case Series. A A Pract 2020;14(9):e01295.
  • 5. Darmon M, Timsit JF, Francais A, et al. Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transplant 2010;25(8):2510-2515.
  • 6. The Royal Children’s Hospital Melbourne. Clinical Practice Guidelines: Hypernatremia Available from:URL:https://www.rch.org.au/clinicalguide/guideline_index/Hypernatraemia/
  • 7. Kovesdy CP, Lott EH, Lu JL, et al. Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure. Circulation. 2012;125(5):677-684.
  • 8. Kellum Ja, Lameire N, Aspelin P, et al. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.
  • 9. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus defnitions for sepsis and septic shock (sepsis-3). JAMA 2016;315:801–10.
  • 10. Buttgereit F, da Silva JAP, Boers M, et al. Standardized nomen-clature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 2002;61:718–22.
  • 11. Giordano M, Ciarambino T, Castellino P, et al. Diseases associated with electrolyte imbalance in the ED: age-related differences. Am J Emerg Med 2016;34(10):1923-1926.
  • 12. Bataille S, Baralla C, Torro D, et al. Undercorrection of hypernatremia is frequent and associated with mortality. BMC Nephrol 2014;15:37.
  • 13. Bricker NS, Dewey RR, Lubowitz H, Stokes J, Kirkensgaard T. Observations on the concentrating and diluting mechanisms of the diseased kidney. J Clin Invest 1959;38:516–23.
  • 14. Kovesdy CP. Significance of hypo-and hypernatremia in chronic kidney disease. Nephrol Dial Transplant. 2012;27(3):891-898.
  • 15. Arzhan S, Lew SQ, Ing TS, Tzamaloukas AH, Unruh ML. Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment. Front Med (Lausanne) 2021;8:769287.
  • 16. Ruiz-Sánchez JG, Núñez-Gil IJ, Cuesta M, et al. Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis. Front Endocrinol (Lausanne) 2020;11:599255.
  • 17. Herrera A J. Hipertensión arterial dependiente de sal [Salt-dependent arterial hypertension]. Arch Cardiol Mex. 2001;71 Suppl 1:S76-S80.
  • 18. Weinberger M, Fineberg N. Sodium and volume sensitivity of blood pressure. Age and pressure change over time. Hypertension 1991;18:67– 71
  • 19. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020;323:1061–1069.
  • 20. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382(18):1708-1720.
  • 21. 2Schiffrin EL, Flack JM, Ito S, Muntner P, Webb RC. Hypertension and COVID-19. Am J Hypertens 2020;33(5):373-374.
  • 22. De Freitas G, Gudur A,Vela-Ortiz M, Jodelka J, Livert D, Krishnamurthy M. Where there is sodium there may be sepsis. J Community Hosp Intern Med Perspect 2019;9(4):296-299.
  • 23. Lindner G, Schwarz C, Funk GC. Osmotic diuresis due to urea as the cause of hypernatraemia in critically ill patients. Nephrol Dial Transplant 2012;27(3):962-967.
  • 24. Bischof E, Wolfe J, Klein SL. Clinical trials for COVID-19 should include sex as a variable. J Clin Invest 2020;130(7):3350-3352.
  • 25. Bienvenu LA, Noonan J, Wang X, Peter K. Higher mortality of COVID-19 in males: sex differences in immune response and cardiovascular comorbidities. Cardiovasc Res 2020;116(14):2197-2206.
  • 26. Peckham H, de Gruijter NM, Raine C, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ICU admission. Nat Commun 2020;11(1):6317.
  • 27. Thunhorst RL, Beltz TG, Johnson AK. Glucocorticoids increase salt appetite by promoting water and sodium excretion. Am J Physiol Regul Integr Comp Physiol 2007;293(3):R1444-R1451.
  • 28. Li C, Wang W, Summer SN, Falk S, Schrier RW. Downregulation of UT-A1/UT-A3 is associated with urinary concentrating defect in glucocorticoid-excess state. J Am Soc Nephrol 2008;19(10):1975-1981.
  • 29. Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y. Corticosteroids for treating sepsis. Cochrane Database Syst Rev 2015;(12):CD002243.
  • 30. Arabi YM, Chrousos GP, Meduri GU. The ten reasons why corticosteroid therapy reduces mortality in severe COVID-19. Intensive Care Med 2020;46(11):2067-2070.
Yıl 2023, Cilt: 9 Sayı: 1, 135 - 146, 28.02.2023
https://doi.org/10.19127/mbsjohs.1225466

Öz

Kaynakça

  • 1. Palevsky PM, Bhagrath R, Greenberg A. Hypernatremia in hospitalized patients. Ann Intern Med 1996;124:197- 203.
  • 2. Lindner G, Funk GC, Schwarz C, et al. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis 2007; 50:952-7.
  • 3. Lindner G, Funk GC. Hypernatremia in critically ill patients. J Crit Care 2013;28(2):216.e11-216.e2.16E20.
  • 4. Zimmer MA, Zink AK, Weisser CW, Vogt U, Michelsen A, Priebe HJ, et al. Hypernatremia-A Manifestation of COVID-19: A Case Series. A A Pract 2020;14(9):e01295.
  • 5. Darmon M, Timsit JF, Francais A, et al. Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transplant 2010;25(8):2510-2515.
  • 6. The Royal Children’s Hospital Melbourne. Clinical Practice Guidelines: Hypernatremia Available from:URL:https://www.rch.org.au/clinicalguide/guideline_index/Hypernatraemia/
  • 7. Kovesdy CP, Lott EH, Lu JL, et al. Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure. Circulation. 2012;125(5):677-684.
  • 8. Kellum Ja, Lameire N, Aspelin P, et al. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.
  • 9. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus defnitions for sepsis and septic shock (sepsis-3). JAMA 2016;315:801–10.
  • 10. Buttgereit F, da Silva JAP, Boers M, et al. Standardized nomen-clature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 2002;61:718–22.
  • 11. Giordano M, Ciarambino T, Castellino P, et al. Diseases associated with electrolyte imbalance in the ED: age-related differences. Am J Emerg Med 2016;34(10):1923-1926.
  • 12. Bataille S, Baralla C, Torro D, et al. Undercorrection of hypernatremia is frequent and associated with mortality. BMC Nephrol 2014;15:37.
  • 13. Bricker NS, Dewey RR, Lubowitz H, Stokes J, Kirkensgaard T. Observations on the concentrating and diluting mechanisms of the diseased kidney. J Clin Invest 1959;38:516–23.
  • 14. Kovesdy CP. Significance of hypo-and hypernatremia in chronic kidney disease. Nephrol Dial Transplant. 2012;27(3):891-898.
  • 15. Arzhan S, Lew SQ, Ing TS, Tzamaloukas AH, Unruh ML. Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment. Front Med (Lausanne) 2021;8:769287.
  • 16. Ruiz-Sánchez JG, Núñez-Gil IJ, Cuesta M, et al. Prognostic Impact of Hyponatremia and Hypernatremia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis. Front Endocrinol (Lausanne) 2020;11:599255.
  • 17. Herrera A J. Hipertensión arterial dependiente de sal [Salt-dependent arterial hypertension]. Arch Cardiol Mex. 2001;71 Suppl 1:S76-S80.
  • 18. Weinberger M, Fineberg N. Sodium and volume sensitivity of blood pressure. Age and pressure change over time. Hypertension 1991;18:67– 71
  • 19. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020;323:1061–1069.
  • 20. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382(18):1708-1720.
  • 21. 2Schiffrin EL, Flack JM, Ito S, Muntner P, Webb RC. Hypertension and COVID-19. Am J Hypertens 2020;33(5):373-374.
  • 22. De Freitas G, Gudur A,Vela-Ortiz M, Jodelka J, Livert D, Krishnamurthy M. Where there is sodium there may be sepsis. J Community Hosp Intern Med Perspect 2019;9(4):296-299.
  • 23. Lindner G, Schwarz C, Funk GC. Osmotic diuresis due to urea as the cause of hypernatraemia in critically ill patients. Nephrol Dial Transplant 2012;27(3):962-967.
  • 24. Bischof E, Wolfe J, Klein SL. Clinical trials for COVID-19 should include sex as a variable. J Clin Invest 2020;130(7):3350-3352.
  • 25. Bienvenu LA, Noonan J, Wang X, Peter K. Higher mortality of COVID-19 in males: sex differences in immune response and cardiovascular comorbidities. Cardiovasc Res 2020;116(14):2197-2206.
  • 26. Peckham H, de Gruijter NM, Raine C, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ICU admission. Nat Commun 2020;11(1):6317.
  • 27. Thunhorst RL, Beltz TG, Johnson AK. Glucocorticoids increase salt appetite by promoting water and sodium excretion. Am J Physiol Regul Integr Comp Physiol 2007;293(3):R1444-R1451.
  • 28. Li C, Wang W, Summer SN, Falk S, Schrier RW. Downregulation of UT-A1/UT-A3 is associated with urinary concentrating defect in glucocorticoid-excess state. J Am Soc Nephrol 2008;19(10):1975-1981.
  • 29. Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y. Corticosteroids for treating sepsis. Cochrane Database Syst Rev 2015;(12):CD002243.
  • 30. Arabi YM, Chrousos GP, Meduri GU. The ten reasons why corticosteroid therapy reduces mortality in severe COVID-19. Intensive Care Med 2020;46(11):2067-2070.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Özgür Kılıç 0000-0001-7194-8569

Mehmet Polat 0000-0003-1952-4237

Kamil Sannah 0000-0002-8428-5191

Melda Dilek 0000-0001-6808-4819

Yayımlanma Tarihi 28 Şubat 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 9 Sayı: 1

Kaynak Göster

Vancouver Kılıç Ö, Polat M, Sannah K, Dilek M. Hypernatremia in Critically Ill COVID-19 Patients: Is it a manifestation of COVID-19 or acquired in the ICU?. Middle Black Sea Journal of Health Science. 2023;9(1):135-46.

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