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Electrolyte imbalances as poor prognostic markers in COVID-19: a systemic review and meta-analysis.
Song, H J J M D; Chia, A Z Q; Tan, B K J; Teo, C B; Lim, V; Chua, H R; Samuel, M; Kee, A.
  • Song HJJMD; Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
  • Chia AZQ; Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
  • Tan BKJ; Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
  • Teo CB; Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
  • Lim V; Department of Medicine, National University Hospital (NUH), Singapore, Singapore.
  • Chua HR; Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
  • Samuel M; Department of Medicine, National University Hospital (NUH), Singapore, Singapore.
  • Kee A; Systematic Review Unit, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
J Endocrinol Invest ; 2022 Sep 07.
Article in English | MEDLINE | ID: covidwho-2245369
ABSTRACT

PURPOSE:

Serum electrolyte imbalances are highly prevalent in COVID-19 patients. However, their associations with COVID-19 outcomes are inconsistent, and of unknown prognostic value. We aim to systematically clarify the associations and prognostic accuracy of electrolyte imbalances (sodium, calcium, potassium, magnesium, chloride and phosphate) in predicting poor COVID-19 clinical outcome.

METHODS:

PubMed, Embase and Cochrane Library were searched. Odds of poor clinical outcome (a composite of mortality, intensive-care unit (ICU) admission, need for respiratory support and acute respiratory distress syndrome) were pooled using mixed-effects models. The associated prognostic sensitivity, positive and negative likelihood ratios (LR + , LR-) and predictive values (PPV, NPV; assuming 25% pre-test probability), and area under the curve (AUC) were computed.

RESULTS:

We included 28 observational studies from 953 records with low to moderate risk-of-bias. Hyponatremia (OR = 2.08, 95% CI = 1.48-2.94, I2 = 93%, N = 8), hypernatremia (OR = 4.32, 95% CI = 3.17-5.88, I2 = 45%, N = 7) and hypocalcemia (OR = 3.31, 95% CI = 2.24-4.88, I2 = 25%, N = 6) were associated with poor COVID-19 outcome. These associations remained significant on adjustment for covariates such as demographics and comorbidities. Hypernatremia was 97% specific in predicting poor outcome (LR + 4.0, PPV = 55%, AUC = 0.80) despite no differences in CRP and IL-6 levels between hypernatremic and normonatremic patients. Hypocalcemia was 76% sensitive in predicting poor outcome (LR- 0.44, NPV = 87%, AUC = 0.71). Overall quality of evidence ranged from very low to moderate.

CONCLUSION:

Hyponatremia, hypernatremia and hypocalcemia are associated with poor COVID-19 clinical outcome. Hypernatremia is 97% specific for a poor outcome, and the association is independent of inflammatory marker levels. Further studies should evaluate if correcting these imbalances help improve clinical outcome.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Reviews Language: English Year: 2022 Document Type: Article Affiliation country: S40618-022-01877-5

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Reviews Language: English Year: 2022 Document Type: Article Affiliation country: S40618-022-01877-5