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1.
Am J Physiol Regul Integr Comp Physiol ; 321(6): R833-R843, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1541942

ABSTRACT

Angiotensin-converting enzyme 2 (ACE2) is a membrane-bound protein containing 805 amino acids. ACE2 shows approximately 42% sequence similarity to somatic ACE but has different biochemical activities. The key role of ACE2 is to catalyze the vasoconstrictor peptide angiotensin (ANG) II to Ang-(1-7), thus regulating the two major counterbalancing pathways of the renin-angiotensin system (RAS). In this way, ACE2 plays a protective role in end-organ damage by protecting tissues from the proinflammatory actions of ANG II. The circulating RAS is activated in normal pregnancy and is essential for maintaining fluid and electrolyte homeostasis and blood pressure. Renin-angiotensin systems are also found in the conceptus. In this review, we summarize the current knowledge on the regulation and function of circulating and uteroplacental ACE2 in uncomplicated and complicated pregnancies, including those affected by preeclampsia and fetal growth restriction. Since ACE2 is the receptor for SARS-CoV-2, and COVID-19 in pregnancy is associated with more severe disease and increased risk of abnormal pregnancy outcomes, we also discuss the role of ACE2 in mediating some of these adverse consequences. We propose that dysregulation of ACE2 plays a critical role in the development of preeclampsia, fetal growth restriction, and COVID-19-associated pregnancy pathologies and suggest that human recombinant soluble ACE2 could be a novel therapeutic to treat and/or prevent these pregnancy complications.


Subject(s)
Angiotensin-Converting Enzyme 2/metabolism , Placenta/enzymology , Pregnancy Complications/enzymology , Renin-Angiotensin System , Uterus/enzymology , Angiotensin-Converting Enzyme 2/therapeutic use , Animals , Blood Pressure , COVID-19/enzymology , COVID-19/physiopathology , COVID-19/virology , Female , Fetal Growth Retardation/enzymology , Fetal Growth Retardation/physiopathology , Humans , Inflammation Mediators/metabolism , Placenta/physiopathology , Pre-Eclampsia/enzymology , Pre-Eclampsia/physiopathology , Pregnancy , Pregnancy Complications/drug therapy , Pregnancy Complications/physiopathology , Pregnancy Complications, Infectious/enzymology , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/virology , SARS-CoV-2/pathogenicity , Uterus/physiopathology , Water-Electrolyte Balance
2.
Nutrients ; 13(9)2021 Aug 25.
Article in English | MEDLINE | ID: covidwho-1394978

ABSTRACT

The beverage hydration index (BHI) facilitates a comparison of relative hydration properties of beverages using water as the standard. The additive effects of electrolytes, carbohydrate, and protein on rehydration were assessed using BHI. Nineteen healthy young adults completed four test sessions in randomized order: deionized water (W), electrolytes only (E), carbohydrate-electrolytes (C + E), and 2 g/L dipeptide (alanyl-glutamine)-electrolytes (AG + E). One liter of beverage was consumed, after which urine and body mass were obtained every 60 min through 240 min. Compared to W, BHI was higher (p = 0.007) for C + E (1.15 ± 0.17) after 120 min and for AG + E (p = 0.021) at 240 min (1.15 ± 0.20). BHI did not differ (p > 0.05) among E, C + E, or AG + E; however, E contributed the greatest absolute net effect (>12%) on BHI relative to W. Net fluid balance was lower for W (p = 0.048) compared to C + E and AG + E after 120 min. AG + E and E elicited higher (p < 0.001) overall urine osmolality vs. W. W also elicited greater reports of stomach bloating (p = 0.02) compared to AG + E and C + E. The addition of electrolytes alone (in the range of sports drinks) did not consistently improve BHI versus water; however, the combination with carbohydrate or dipeptides increased fluid retention, although this occurred earlier for the sports drink than the dipeptide beverage. Electrolyte content appears to make the largest contribution in hydration properties of beverages for young adults when consumed at rest.


Subject(s)
Beverages/analysis , Dehydration/prevention & control , Dietary Carbohydrates/pharmacology , Dietary Proteins/pharmacology , Electrolytes/pharmacology , Water-Electrolyte Balance/physiology , Adult , Dietary Carbohydrates/urine , Dietary Proteins/urine , Double-Blind Method , Electrolytes/analysis , Electrolytes/urine , Female , Humans , Male , Time Factors , Water/administration & dosage , Young Adult
3.
BMJ Open Qual ; 10(3)2021 08.
Article in English | MEDLINE | ID: covidwho-1367441

ABSTRACT

Reviewing fluid balance charts is a simple and effective method of assessing and monitoring the hydration status of patients. Several articles report that these charts are often either inaccurately or incompletely filled thereby limiting their usefulness in clinical practice. We had a similar experience in our practice at Kettering General Hospital and conducted a quality improvement project with a goal to increase the number of charts that were completely and accurately filled by a minimum of 50% in a 1-month period and to reassess the sustainability of this improvement after 6 months. Data from baseline measurements showed that only 25% of the charts in the ward had accurate measurements, 20% had correct daily totals and 14% had complete records of all intakes and losses. We collected feedback from nursing staff in the ward on what challenges they faced in using these charts and how best to support them. Corroborated by evidence from the literature, we discovered that inadequate training was a major factor responsible for the poor quality of documentation in these charts. Using simultaneous plan-do-study-act cycles, we designed and delivered personalised teaching on fluid balance chart documentation to the nursing staff. Subsequent data showed remarkable improvements in all the parameters we assessed. For instance, the proportion of charts with accurate measurements increased by 55% and those with complete entries by 122%. Unfortunately, we were unable to demonstrate sustainability of these improvements as our second set of data collection coincided with the SARS-CoV-2 outbreak. In this project, we were able to demonstrate that simple and cost-efficient measures such as adequate training of nursing staff could remarkably improve the quality of fluid balance charts used in our hospitals. We suggest that this training should be included as part of the regular competency assessments for nurses and other healthcare staff.


Subject(s)
COVID-19 , Quality Improvement , Documentation , Humans , SARS-CoV-2 , Water-Electrolyte Balance
4.
Diabetes Metab Syndr ; 15(5): 102240, 2021.
Article in English | MEDLINE | ID: covidwho-1347578

ABSTRACT

AIMS: To evaluate calculated total plasma osmolality as a marker of outcome prediction, fluid and metabolic balance, thrombotic risk in severe COVID-19 patients. METHODS: Retrospective data of RT-PCR confirmed hospitalized severe COVID-19 patients (total: n = 175 patients, including diabetic subset: n = 102) were analyzed. Clinically applicable cut-offs were derived using receiver operating characteristic (ROC) curve analysis for calculated total osmolality, eGFR, and D-dimer, and their correlations were studied. RESULTS: Among 175 severe COVID-19 patients, a significant association with mortality was seen with respect to calculated total osmolality (p < 0.001), eGFR (p < 0.001), and D-dimer (p < 0.001). In the total cohort, applicable cut-offs based on ROC curve in predicting outcome were, for total osmolality 299 mosm/kg (area under the curve (AUC)-0.773, odds ratio (OR)-1.09), eGFR 61.5 ml/min/m2 (AUC-0.789, OR-0.96), D-dimer 5.13 (AUC-0.814, OR-2.65) respectively. In diabetic subset, the cut-offs for total osmolality were 298 mosm/kg (AUC-0.794, OR-1.12), eGFR 44.9 ml/min/m2 (AUC-0.774, OR-0.96) and D-dimer 1.59 (AUC-0.769, OR-1.52) respectively. CONCLUSIONS: Applicable cut-offs for calculated total plasma osmolality, eGFR, and D-dimer predicts clinical outcome in severe COVID-19 with and without diabetes. Correlation studies validated calculated total osmolality as a marker of the combined effect of fluid and metabolic imbalance, compromised renal function and hypercoagulability.


Subject(s)
COVID-19/diagnosis , Glomerular Filtration Rate/physiology , Plasma/chemistry , Biomarkers/blood , Blood Coagulation/physiology , COVID-19/blood , COVID-19/physiopathology , COVID-19/therapy , Cohort Studies , Diabetes Complications/blood , Diabetes Complications/diagnosis , Diabetes Complications/physiopathology , Diabetes Complications/therapy , Female , Fibrin Fibrinogen Degradation Products/analysis , Fibrin Fibrinogen Degradation Products/metabolism , Humans , India , Male , Middle Aged , Osmolar Concentration , Patient Admission/statistics & numerical data , Prognosis , Retrospective Studies , Risk Factors , Severity of Illness Index , Thrombosis/blood , Thrombosis/diagnosis , Thrombosis/etiology , Thrombosis/physiopathology , Water-Electrolyte Balance/physiology
5.
Kidney Blood Press Res ; 46(4): 396-410, 2021.
Article in English | MEDLINE | ID: covidwho-1299258

ABSTRACT

BACKGROUND: Patients affected by chronic kidney disease are at a risk of cardiovascular morbidity and mortality. Body fluids unbalance is one of the main characteristics of this condition, as fluid overload is highly prevalent in patients affected by the cardiorenal syndrome. SUMMARY: We describe the state of the art and new insights into body volume evaluation. The mechanisms behind fluid balance are often complex, mainly because of the interplay of multiple regulatory systems. Consequently, its management may be challenging in clinical practice and even more so out-of-hospital. Availability of novel technologies offer new opportunities to improve the quality of care and patients' outcome. Development and validation of new technologies could provide new tools to reduce costs for the healthcare system, promote personalized medicine, and boost home care. Due to the current COVID-19 pandemic, a proper monitoring of chronic patients suffering from fluid unbalances is extremely relevant. Key Message: We discuss the main mechanisms responsible for fluid overload in different clinical contexts, including hemodialysis, peritoneal dialysis, and heart failure, emphasizing the potential impact provided by the implementation of the new technologies.


Subject(s)
Biomedical Technology/trends , Blood Volume , Kidney Failure, Chronic/physiopathology , Renal Insufficiency, Chronic/physiopathology , Water-Electrolyte Balance , COVID-19 , Humans , Kidney Failure, Chronic/mortality , Pandemics , Renal Insufficiency, Chronic/mortality
6.
BMC Infect Dis ; 21(1): 465, 2021 May 21.
Article in English | MEDLINE | ID: covidwho-1238707

ABSTRACT

BACKGROUND: Coronavirus Disease-2019 (COVID-19) has been declared a global pandemic since March 11th, 2020. Despite emerging reports and literature covering a broad spectrum of COVID-19 clinical manifestations, facets of COVID-19 have not been fully elucidated. To the authors' concern, sinus bradycardia as a manifestation of COVID-19-induced syndrome of inappropriate antidiuretic hormone (SIADH) has never been reported before. CASE PRESENTATION: In this paper, we report a case of a 59-year-old male patient with confirmed COVID-19 initially presented with presyncope. Further investigations reveal sinus bradycardia related to COVID-19-induced SIADH. This case highlights the possibility of immuno-neuroendocrino-cardiovascular crosstalk resulting in an atypical manifestation of COVID-19: near syncope due to sinus bradycardia. CONCLUSIONS: Another possible cause of sinus bradycardia in COVID-19 is electrolyte imbalance due to COVID-19-related SIADH.


Subject(s)
Bradycardia/diagnosis , COVID-19/diagnosis , Inappropriate ADH Syndrome/diagnosis , SARS-CoV-2 , Bradycardia/complications , Bradycardia/physiopathology , COVID-19/complications , Diagnosis, Differential , Electrocardiography , Humans , Inappropriate ADH Syndrome/complications , Male , Middle Aged , Water-Electrolyte Balance
7.
BMC Nephrol ; 22(1): 92, 2021 03 15.
Article in English | MEDLINE | ID: covidwho-1136211

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes. METHODS: We reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 14th March 2020 until 12th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 3rd of September 2020. RESULTS: A total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, invasive mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 12.5 days. The mortality was 25% for the AKI group compared to 6.7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in all patients. CONCLUSION: Acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay. Recovery of renal function was complete in all survived patients.


Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , APACHE , Acute Kidney Injury/epidemiology , Acute Kidney Injury/mortality , Acute Kidney Injury/therapy , COVID-19/epidemiology , Cohort Studies , Critical Illness , Female , Hospital Mortality , Humans , Incidence , Intensive Care Units , Male , Middle Aged , Organ Dysfunction Scores , Recovery of Function , Renal Replacement Therapy/statistics & numerical data , Respiration, Artificial/adverse effects , Risk Factors , Water-Electrolyte Balance
8.
Cardiol Young ; 31(3): 485-487, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1131993

ABSTRACT

A four- and a half-month-old girl with severe dilated cardiomyopathy due to neonatal enterovirus myocarditis, treated with diuretics and milrinone for the past 4 months, was infected with SARS-CoV-2. The disease course was characterised by high fever and gastrointestinal symptoms. Cardiac function, as measured by echocardiography, remained stable. The treatment focused on maintaining a normal heart rate and a stable fluid balance. In children with severe underlying cardiac disease, even a mild SARS-CoV-2 infection can require close monitoring and compound treatment.


Subject(s)
COVID-19/physiopathology , Cardiomyopathy, Dilated/physiopathology , Diarrhea/physiopathology , Fever/physiopathology , Tachycardia/physiopathology , Tachypnea/physiopathology , Ventricular Dysfunction, Left/physiopathology , Vomiting/physiopathology , COVID-19/complications , Cardiomyopathy, Dilated/drug therapy , Cardiomyopathy, Dilated/etiology , Cardiomyopathy, Dilated/metabolism , Cardiotonic Agents/therapeutic use , Diuretics/therapeutic use , Echocardiography , Enterovirus Infections/complications , Female , Heart Rate , Heart Transplantation , Humans , Infant , Milrinone/therapeutic use , Myocarditis/complications , Natriuretic Peptide, Brain/metabolism , Peptide Fragments/metabolism , SARS-CoV-2 , Severity of Illness Index , Troponin T/metabolism , Ventricular Dysfunction, Left/drug therapy , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/metabolism , Waiting Lists , Water-Electrolyte Balance
9.
Cardiorenal Med ; 10(6): 470-475, 2020.
Article in English | MEDLINE | ID: covidwho-809051

ABSTRACT

With the global spread of SARS-Cov-2 infections, increasing numbers of COVID-19 cases have been reported in transplant recipients. However, reports are lacking concerning the treatment and prognosis of COVID-19 pneumonia in renal transplant recipients with acute cardiorenal syndrome. We report here the complete clinical course of a renal transplant recipient with critical COVID-19 pneumonia. In the early phase of SARS-Cov-2 infection, the patient exhibited extensive lung lesions and significant acute kidney and heart injuries, which required treatment in the ICU. After correcting the arrhythmia and heart failure, the patient recovered quickly from the acute kidney injury with a treatment of intensive diuresis and strict control of fluid intake. Without cessation of oral immunosuppressive agents, the patient presented a delayed and low antibody response against SARS-Cov-2 and reappeared positive for the virus twice after being discharged. Nevertheless, the patient's pneumonia continued to improve and he fully recovered in 69 days. This effectively treated case may be meaningful and referable for the treatment of COVID-19 pneumonia in other transplant recipients with acute cardiorenal syndrome.


Subject(s)
COVID-19/complications , Cardio-Renal Syndrome/etiology , Kidney Transplantation/adverse effects , SARS-CoV-2/genetics , Acute Disease , Antibody Formation/immunology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Cardio-Renal Syndrome/drug therapy , Diuretics/therapeutic use , Humans , Immunocompromised Host/immunology , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Noninvasive Ventilation/methods , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2/immunology , Transplant Recipients , Treatment Outcome , Water-Electrolyte Balance
10.
Iran J Kidney Dis ; 14(5): 331-334, 2020 09.
Article in English | MEDLINE | ID: covidwho-777018

ABSTRACT

Coronavirus family has caused several human illnesses, the latest caused by SARS-CoV-2, has led to COVID-19 pandemic posing serious threat to global health. A SARS-CoV-2 variant encoding a D614G mutation in the viral spike (S) protein has now become the most prevalent form of the virus worldwide, suggesting a fitness advantage for the mutant. The G614 variant is associated with higher upper respiratory tract viral load, higher infectivity, increased total S protein incorporation into the virion, reduced S1 shedding and a conformational change leading to a more ACE2- binding and fusion- competent state. However, it does not seem to be correlated to increased disease severity or escape neutralizing antibodies.


Subject(s)
Coronavirus Infections , Pandemics , Peptidyl-Dipeptidase A , Pneumonia, Viral , Water-Electrolyte Balance , Betacoronavirus , COVID-19 , Coronary Artery Bypass , Humans , Length of Stay , SARS-CoV-2 , Spike Glycoprotein, Coronavirus
11.
Postgrad Med J ; 97(1145): 175-179, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-691133

ABSTRACT

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread in nearly 200 countries in less than 4 months since its first identification; accordingly, the coronavirus disease 2019 (COVID 2019) has affirmed itself as a clinical challenge. The prevalence of pre-existing cardiovascular diseases in patients with COVID19 is high and this dreadful combination dictates poor prognosis along with the higher risk of intensive care mortality. In the setting of chronic heart failure, SARS-CoV-2 can be responsible for myocardial injury and acute decompensation through various mechanisms. Given the clinical and epidemiological complexity of COVID-19, patiens with heart failure may require particular care since the viral infection has been identified, considering an adequate re-evaluation of medical therapy and a careful monitoring during ventilation.


Subject(s)
COVID-19/therapy , Heart Failure/therapy , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Angiotensin-Converting Enzyme 2/metabolism , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19/complications , COVID-19/drug therapy , COVID-19/physiopathology , Diagnosis, Differential , Diuretics/therapeutic use , Edema, Cardiac/diagnostic imaging , Fluid Therapy , Heart Failure/complications , Heart Failure/physiopathology , Humans , Myocardium/metabolism , Pulmonary Edema/diagnostic imaging , SARS-CoV-2 , Tomography, X-Ray Computed , Troponin/metabolism , Ultrasonography , Water-Electrolyte Balance
12.
Kidney Blood Press Res ; 45(4): 612-622, 2020.
Article in English | MEDLINE | ID: covidwho-680430

ABSTRACT

INTRODUCTION: Severe acute respiratory viral infections are frequency accompanied by multiple organ dysfunction, including acute kidney injury (AKI). In December 2019, the coronavirus disease 2019 (COVID-19) outbreak began in Wuhan, Hubei Province, China, and rapidly spread worldwide. While diffuse alveolar damage and acute respiratory failure are the main features of COVID-19, other organs may be involved, and the incidence of AKI is not well described. We assessed the incidence and clinical characteristics of AKI in patients with laboratory-confirmed COVID-19 and its effects on clinical outcomes. METHODS: We conducted a multicenter, retrospective, observational study of patients with COVID-19 admitted to two general hospitals in Wuhan from 5 January 2020 to 21 March 2020. Demographic data and information on organ dysfunction were collected daily. AKI was defined according to the KDIGO clinical practice guidelines. Early and late AKI were defined as AKI occurring within 72 h after admission or after 72 h, respectively. RESULTS: Of the 116 patients, AKI developed in 21 (18.1%) patients. Among them, early and late AKI were found in 13 (11.2%) and 8 (6.9%) patients, respectively. Compared with patients without AKI, patients with AKI had more severe organ dysfunction, as indicated by a higher level of disease severity status, higher sequential organ failure assessment (SOFA) score on admission, an increased prevalence of shock, and a higher level of respiratory support. Patients with AKI had a higher SOFA score on admission (4.5 ± 2.1 vs. 2.8 ± 1.4, OR 1.498, 95% CI 1.047-2.143 ) and greater hospital mortality (57.1% vs. 12.6%, OR 3.998, 95% CI 1.088-14.613) than patients without AKI in both the univariate and multivariate analyses. Patients with late AKI, but not those with early AKI, had a significantly prolonged length of stay (19.6 vs. 9.6 days, p = 0.015). CONCLUSION: Our findings show that admission SOFA score was an independent risk factor for AKI in COVID-19 patients, and patients with AKI had higher in-hospital mortality. Moreover, AKI development after 72 h of admission was related to prolonged hospitalization time.


Subject(s)
Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Coronavirus Infections/complications , Pneumonia, Viral/complications , Acute Kidney Injury/mortality , Adult , Aged , Aged, 80 and over , COVID-19 , China/epidemiology , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Disease Progression , Female , Hospital Mortality , Hospitals, General , Humans , Incidence , Kidney Function Tests , Length of Stay , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Organ Failure/therapy , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Retrospective Studies , Treatment Outcome , Water-Electrolyte Balance
13.
Diagnosis (Berl) ; 7(4): 365-372, 2020 Nov 18.
Article in English | MEDLINE | ID: covidwho-615210

ABSTRACT

Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory disease, which can evolve into multi-organ failure (MOF), leading to death. Several biochemical alterations have been described in COVID-19 patients. To date, many biomarkers reflecting the main pathophysiological characteristics of the disease have been identified and associated with the risk of developing severe disease. Lymphopenia represents the hallmark of the disease, and it can be detected since the early stage of infection. Increased levels of several inflammatory biomarkers, including c-reactive protein, have been found in COVID-19 patients and associated with an increased risk of severe disease, which is characterised by the so-called "cytokine storm". Also, the increase of cardiac and liver dysfunction biomarkers has been associated with poor outcome. In this review, we provide an overview of the main biochemical characteristics of COVID-19 and the associated biomarkers alterations.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/metabolism , Pneumonia, Viral/metabolism , Aged , Aged, 80 and over , Betacoronavirus/isolation & purification , Biomarkers , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/metabolism , C-Reactive Protein/analysis , COVID-19 , Coronavirus Infections/classification , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Cytokines/metabolism , Disease Progression , Humans , Inflammation/complications , Inflammation/metabolism , Inflammation/virology , Kidney Diseases/metabolism , Kidney Diseases/physiopathology , Liver Diseases/etiology , Liver Diseases/metabolism , Lymphopenia/etiology , Muscles/injuries , Muscles/metabolism , Myocardial Infarction/etiology , Myocardial Infarction/metabolism , Pandemics/classification , Pneumonia, Viral/classification , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2 , Severity of Illness Index , Water-Electrolyte Balance/physiology
14.
Ann Clin Biochem ; 57(3): 262-265, 2020 05.
Article in English | MEDLINE | ID: covidwho-215069

ABSTRACT

BACKGROUND: Early studies have reported various electrolyte abnormalities at admission in patients who progress to the severe form of coronavirus disease 2019 (COVID-19). As electrolyte imbalance may not only impact patient care, but provide insight into the pathophysiology of COVID-19, we aimed to analyse all early data reported on electrolytes in COVID-19 patients with and without severe form. METHODS: An electronic search of Medline (PubMed interface), Scopus and Web of Science was performed for articles comparing electrolytes (sodium, potassium, chloride and calcium) between COVID-19 patients with and without severe disease. A pooled analysis was performed to estimate the weighted mean difference (WMD) with 95% confidence interval. RESULTS: Five studies with a total sample size of 1415 COVID-19 patients. Sodium was significantly lower in patients with severe COVID-19 (WMD: -0.91 mmol/L [95% CI: -1.33 to -0.50 mmol/L]). Similarly, potassium was also significantly lower in COVID-19 patients with severe disease (WMD: -0.12 mmol/L [95% CI: -0.18 to -0.07 mmol/L], I2=33%). For chloride, no statistical differences were observed between patients with severe and non-severe COVID-19 (WMD: 0.30 mmol/L [95% CI: -0.41 to 1.01 mmol/L]). For calcium, a statistically significant lower concentration was noted in patients with severe COVID-19 (WMD: -0.20 mmol/L [95% CI: -0.25 to -0.20 mmol/L]). CONCLUSIONS: This pooled analysis confirms that COVID-19 severity is associated with lower serum concentrations of sodium, potassium and calcium. We recommend electrolytes be measured at initial presentation and serially monitored during hospitalization in order to establish timely and appropriate corrective actions.


Subject(s)
Coronavirus Infections/blood , Electrolytes/blood , Pneumonia, Viral/blood , Betacoronavirus , COVID-19 , Calcium/blood , Chlorides/blood , Coronavirus Infections/physiopathology , Humans , Pandemics , Pneumonia, Viral/physiopathology , Potassium/blood , SARS-CoV-2 , Sodium/blood , Water-Electrolyte Balance
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