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1.
Eur J Endocrinol ; 185(4): R103-R111, 2021 Sep 06.
Article in English | MEDLINE | ID: covidwho-1348376

ABSTRACT

This review examines the prevalence, aetiology, pathophysiology, prognostic value, and investigation of dysnatraemia in hospitalised COVID-19 patients, taking into account all relevant studies published in PubMed and Cochrane Library studies until March 2021. Hyponatraemia is commonly observed in patients with bacterial pneumonia and is an independent predictor for excess mortality and morbidity. However, it remains unknown whether this association applies to coronavirus disease-2019 (COVID-19). Several studies reported a 20-35% prevalence for hyponatraemia and 2-5% for hypernatraemia in patients admitted with COVID-19. In addition, hyponatraemia on admission was a risk factor for progression to severe disease, being associated with an increased likelihood for the need for invasive mechanical ventilation, with an odds ratio (OR) of 1.83-3.30. Hyponatraemia seems to be an independent risk factor for mortality, with an OR of 1.40-1.50 compared to normonatraemia, while hypernatraemia is related to even worse outcomes than hyponatraemia. Furthermore, preliminary data show an inverse association between serum sodium and interleukin-6 levels, suggesting that hyponatraemia might be used as a surrogate marker for the risk of a cytokine storm and the need for treatment with interleukin antagonists. In conclusion, dysnatraemia is common and carries a poor prognosis in COVID-19 patients, indicating that it may play a future role in risk stratification and individualising therapy.


Subject(s)
COVID-19 , Hypernatremia , Hyponatremia , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Hospitalization/statistics & numerical data , Humans , Hypernatremia/diagnosis , Hypernatremia/epidemiology , Hypernatremia/etiology , Hypernatremia/therapy , Hyponatremia/diagnosis , Hyponatremia/epidemiology , Hyponatremia/etiology , Hyponatremia/therapy , Pandemics , Predictive Value of Tests , Prevalence , Prognosis , Risk Factors , Severity of Illness Index
2.
Medicine (Baltimore) ; 100(9): e24604, 2021 Mar 05.
Article in English | MEDLINE | ID: covidwho-1114903

ABSTRACT

ABSTRACT: Mortality of critically ill patients with coronavirus disease 2019 (COVID-19) was high. Aims to examine whether time from symptoms onset to intensive care unit (ICU) admission affects incidence of extra-pulmonary complications and prognosis in order to provide a new insight for reducing the mortality. A single-centered, retrospective, observational study investigated 45 critically ill patients with COVID-19 hospitalized in ICU of The Third People's Hospital of Yichang from January 17 to March 29, 2020. Patients were divided into 2 groups according to time from symptoms onset to ICU admission (>7 and ≤7 days) and into 2 groups according to prognosis (survivors and non-survivors). Epidemiological, clinical, laboratory, radiological characteristics and treatment data were studied. Compared with patients who admitted to the ICU since symptoms onset ≤7 days (55.6%), patients who admitted to the ICU since symptoms onset >7 days (44.4%) were more likely to have extra-pulmonary complications (19 [95.0%] vs 16 [64.0%], P = .034), including acute kidney injury, cardiac injury, acute heart failure, liver dysfunction, gastrointestinal hemorrhage, hyperamylasemia, and hypernatremia. The incidence rates of acute respiratory distress syndrome, pneumothorax, and hospital-acquired pneumonia had no difference between the 2 groups. Except activated partial thromboplastin and Na+ concentration, the laboratory findings were worse in group of time from symptoms onset to ICU admission >7 days. There was no difference in mortality between the 2 groups. Of the 45 cases in the ICU, 19 (42.2%) were non-survivors, and 16 (35.6%) were with hospital-acquired pneumonia. Among these non-survivors, hospital-acquired pneumonia was up to 12 (63.2%) besides higher incidence of extra-pulmonary complications. However, hospital-acquired pneumonia occurred in only 4 (15.4%) survivors. Critically ill patients with COVID-19 who admitted to ICU at once might get benefit from intensive care via lower rate of extra-pulmonary complications.


Subject(s)
COVID-19 , Critical Care , Critical Illness , Symptom Assessment , Time-to-Treatment/statistics & numerical data , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , COVID-19/complications , COVID-19/diagnosis , COVID-19/mortality , COVID-19/physiopathology , China/epidemiology , Critical Care/methods , Critical Care/statistics & numerical data , Critical Illness/mortality , Critical Illness/therapy , Digestive System Diseases/diagnosis , Digestive System Diseases/etiology , Female , Healthcare-Associated Pneumonia/diagnosis , Healthcare-Associated Pneumonia/mortality , Heart Diseases/diagnosis , Humans , Hyperamylasemia/diagnosis , Hyperamylasemia/etiology , Hypernatremia/diagnosis , Hypernatremia/etiology , Male , Middle Aged , Outcome and Process Assessment, Health Care , Prognosis , SARS-CoV-2/isolation & purification , Survival Analysis , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data
3.
J Clin Endocrinol Metab ; 106(6): 1637-1648, 2021 05 13.
Article in English | MEDLINE | ID: covidwho-1099909

ABSTRACT

CONTEXT: Dysnatremia is an independent predictor of mortality in patients with bacterial pneumonia. There is paucity of data about the incidence and prognostic impact of abnormal sodium concentration in patients with coronavirus disease 2019 (COVID-19). OBJECTIVE: This work aimed to examine the association of serum sodium during hospitalization with key clinical outcomes, including mortality, need for advanced respiratory support and acute kidney injury (AKI), and to explore the role of serum sodium as a marker of inflammatory response in COVID-19. METHODS: This retrospective longitudinal cohort study, including all adult patients who presented with COVID-19 to 2 hospitals in London over an 8-week period, evaluated the association of dysnatremia (serum sodium < 135 or > 145 mmol/L, hyponatremia, and hypernatremia, respectively) at several time points with inpatient mortality, need for advanced ventilatory support, and AKI. RESULTS: The study included 488 patients (median age, 68 years). At presentation, 24.6% of patients were hyponatremic, mainly due to hypovolemia, and 5.3% hypernatremic. Hypernatremia 2 days after admission and exposure to hypernatremia at any time point during hospitalization were associated with a 2.34-fold (95% CI, 1.08-5.05; P = .0014) and 3.05-fold (95% CI, 1.69-5.49; P < .0001) increased risk of death, respectively, compared to normonatremia. Hyponatremia at admission was linked with a 2.18-fold increase in the likelihood of needing ventilatory support (95% CI, 1.34-3.45, P = .0011). Hyponatremia was not a risk factor for in-hospital mortality, except for the subgroup of patients with hypovolemic hyponatremia. Sodium values were not associated with the risk for AKI and length of hospital stay. CONCLUSION: Abnormal sodium levels during hospitalization are risk factors for poor prognosis, with hypernatremia and hyponatremia being associated with a greater risk of death and respiratory failure, respectively. Serum sodium values could be used for risk stratification in patients with COVID-19.


Subject(s)
COVID-19/epidemiology , COVID-19/mortality , Sodium/blood , Acute Lung Injury/epidemiology , Acute Lung Injury/etiology , Aged , Aged, 80 and over , COVID-19/blood , Cohort Studies , Female , Hospital Mortality , Humans , Hypernatremia/etiology , Hypernatremia/mortality , Hyponatremia/etiology , Hyponatremia/mortality , Incidence , Length of Stay , London/epidemiology , Longitudinal Studies , Male , Middle Aged , Predictive Value of Tests , Prognosis , Respiration, Artificial , Risk Factors , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/etiology
4.
Clin Nutr ESPEN ; 43: 495-500, 2021 06.
Article in English | MEDLINE | ID: covidwho-1095915

ABSTRACT

BACKGROUND: There is a lack of evidence about the tolerance of enteral nutrition (EN) in COVID-19 critically ill patients. However, several gastrointestinal manifestations related to COVID-19 have been described. The aims of this study were to analyze the incidence of gastrointestinal intolerance (GI) associated to EN (diarrhea, vomiting, gastroparesis and constipation) and to describe energy/protein provision along with biochemical alterations during the first week of EN. METHODS: A retrospective cohort of COVID-19 critically ill patients under mechanical ventilation. We reported daily enteral nutrition infusion and gastrointestinal manifestations within the first week of intubation and enteral nutrition initiation. RESULTS: Fifty-two patients were included; 40.3% were overweight and 46.2% were obese. During the first 7 days of EN, manifestations of GI intolerance such as vomiting, diarrhea and gastroparesis were present in 18 patients (32.4%). Hypernatremia (39%) was the most frequent electrolyte abnormality. Only Acute Kidney Injury (AKI) diagnosis was associated with a higher energy deficit on day 7. No associations between drug prescription and GI intolerance were observed. On day 4, 94.5% of patients were receiving more than 80% of energy requirements and 94.2% of protein requirements. Accumulated energy and protein deficits at day 3 were 2171.2 ± 945 kcal and 114.9 ± 49.2 g, respectively; and 2586.4 ± 1151 kcal, 133.3 ± 60.4 g at day 7. CONCLUSION: Enteral nutrition is feasible and well-tolerated in COVID-19 patients with mechanical ventilation within the first week of enteral nutrition initiation. More studies are needed to elucidate the impact of nutritional therapy on infection course and outcomes.


Subject(s)
COVID-19 , Critical Illness/therapy , Energy Intake , Enteral Nutrition/adverse effects , Gastrointestinal Diseases/etiology , Nutritional Requirements , Respiration, Artificial , Acute Kidney Injury/etiology , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Constipation/etiology , Diarrhea/etiology , Female , Gastroparesis/etiology , Humans , Hypernatremia/etiology , Intensive Care Units , Male , Middle Aged , Nutritional Status , Retrospective Studies , SARS-CoV-2 , Vomiting/etiology
5.
Rev Endocr Metab Disord ; 22(2): 317-324, 2021 06.
Article in English | MEDLINE | ID: covidwho-1064568

ABSTRACT

SARS-COV2 infection has swiftly become a pandemic disease of historic relevance and widely variable outcomes. This variable prognosis is related both to uneven damage, among others, to lungs, heart and kidneys, and to a multisystemic inflammatory reaction. All these factors are known to disrupt water balance and potentially induce hyponatraemia or hypernatraemia. Water balance disorders are known mortality and morbidity risk factors in several clinical scenarios and their proper management, though often complex and hazardous, can reduce mortality and length of hospitalization. Clinical uncertainty over COVID-19 outcome, the variety of organs involved in both the infection and water balance and difficulties in clinical examination due to risk of contagion might obstruct proper management of dysnatremic disorders. Thus, the Acqua Neuroendocrinology Group of the Spanish Society for Endocrinology (SEEN) has endeavoured to provide evidence and expert based recommendations on the management of hyponatraemia and hypernatraemia in COVID-19 patients.


Subject(s)
COVID-19/therapy , Consensus , Hypernatremia/therapy , Hyponatremia/therapy , Neuroendocrinology/standards , Practice Guidelines as Topic/standards , Societies, Medical/standards , COVID-19/complications , Humans , Hypernatremia/etiology , Hyponatremia/etiology , Spain
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