Prognostic Impact of Dysnatremia in COVID-19 Pneumonia: Risk Stratification of Hospitalized Patients

Author(s): Madhumita Das, Angela Phukan, Madhab Kalita.

Background and Objectives: Severe dysnatremia is associated with poor prognosis and worse outcome and therefore needs more attention to unravel its relation with poor prognosis in patients admitted with coronavirus disease 2019 (COVID-19). The aim of our study was to determine varying degree of dysnatremia among hospitalized COVID-19 patients and identify the clinical outcome associated with it. Methods: This retrospective record analysis study was conducted on the hospitalized COVID-19 patients in Guwahati Neurological Research Centre Medical, North Guwahati and for every included patient, medical records were scrutinised anonymously. Results: COVID-19 positive participants were divided into four categories like, dysnatremic (serum sodium > 146 or < 134 mmol/L), hypernatremic (> 146 mmol/L), hyponatremic (< 134 mmol/L) and eunatremic (134 - 146 mmol/L). Total 37.9% of the participants exhibited dysnatremia compared to only 20% from the control group demonstrating a significant difference (p = 0.02). Hypernatremia was significantly high (p = 0.01) compared to hyponatremia (27.7% vs 12.3%) and also turned out to be relatively severe with significantly high ICU admittance (p<0.0001) and mortality rate (p = 0.01). Magnitude of dysnatremic patients showing aberration in the other laboratory parameters was significantly high to that of eunatremic group with high fatality rate among hypernatremic. Dysnatremic group demonstrated significantly high SOFA score but mortality risk, based on CURB 65 score and probability of death, was increased in hypernatremic group. Interpretation and Conclusion: Dysnatremia, mainly hypernatremia, is associated with increased mortality and morbidity which highlights the significance of considering it as a predictive marker.