BMJ Open (Nov 2023)

What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals

  • ,
  • Babette Verkouteren,
  • Dan Piña-Fuentes,
  • Martijn Beudel,
  • Thomas Ludden,
  • Rik H G Olde Engberink,
  • Tom Dormans,
  • Martijn D de Kruif,
  • Suat Simsek,
  • Joop P van den Bergh,
  • Hazra Moeniralam,
  • Renee Douma,
  • Kees Brinkman,
  • Wouter Hinsenveld,
  • Lucas Ramos,
  • Anne Pirson,
  • Deborah Hubers,
  • Shi Hu,
  • Rajat Thomas,
  • Michiel Schinkel,
  • Caroline E Wyers,
  • Daisy Rusch,
  • Lianne de Haan,
  • Niels C Gritters van den Oever,
  • Nienke Paternotte,
  • Robert-Jan Goldhoorn,
  • Brent Appelman,
  • Esther Lems,
  • Marije ten Wolde,
  • Esther K Haspels-Hogervorst,
  • Neyma Bokhizzou,
  • Niels Gritters van den Oever,
  • Joop van den Bergh,
  • Martijn de Kruif,
  • Helen Leavis,
  • Derk Arts,
  • Nick Nurmohamed,
  • Rens Reeskamp,
  • Willem Herter,
  • Bas Vonk,
  • Ricardo Lopes,
  • Deborah Huberts,
  • Marije Wolfers,
  • Sander de Kuij,
  • Sophie Noordzij,
  • Sibbeliene van den Bosch,
  • Benthe Verhoef,
  • Michele Methorst,
  • Shahan Darwesh,
  • Tijn van Egmond,
  • Gulsum Nasim,
  • Hamza Ali,
  • Lars de Boer,
  • Myrthe Nagel,
  • Maud Koenis,
  • Agnetha Bijlsma,
  • Britt Balvers,
  • Isabella Ghauharali,
  • Jelle de Jongh,
  • Maira Emanuel,
  • Nisrine Aynaou,
  • Rosemarie de Ridder,
  • Insaff Darraz,
  • Oumaima Darraz,
  • Alanar Cinar,
  • Jesse Roosen,
  • Larissa Heideman,
  • Asabi Leliveld,
  • Dana Ruijter,
  • Neeltje Rosenberg,
  • Djoeke Woutman,
  • Tom Vermeulen,
  • Sam de Joode,
  • Willem Berger,
  • Ozgu Varan,
  • Soesja Pinto,
  • Sientje Sluis,
  • Bibi Kuiper,
  • Tim van der Putten,
  • Dominique Bosje,
  • Mahunda Sinyangwe,
  • Roos van Rhijn,
  • Koen Kruif,
  • Lianne de Haan,
  • Miriam den Heijer,
  • Koen de Kruijf,
  • Sam Hofhuis,
  • Gwendolyn Telting,
  • Susan van der Lei,
  • Pien van Paassen,
  • Emil ter Veer,
  • Krijna Opschoor,
  • Camille Breukhoven,
  • Florine Jiwa,
  • Peter de Gooyer,
  • Jan Vrijdag,
  • Stans van Gelder,
  • Anne Pannekoek,
  • Laura Dommershuijzen,
  • Estelle Adang,
  • Maud van Maren,
  • Isabel Koop,
  • Bart Sanders,
  • Joukje Wanten,
  • Dax Trommelen,
  • Fleur Smeets,
  • Kyra Heuvelings,
  • Maud Cox,
  • Milou Rademaekers,
  • Vivian Hendrikx,
  • Ilona van Rooij,
  • Wendy Heuts,
  • Laura Oudeman,
  • Evelien Brans,
  • Karin Slot,
  • Kirsten Boerma-Argelo,
  • Wilma Kok,
  • Lieke Harmsen,
  • Ingrid Boerema,
  • Anne Raafs,
  • Anne Smaal,
  • Bibiane Pop,
  • Carmen Waterink,
  • Casper Vrij,
  • Daphne van der Willik,
  • Frederic Reitsma,
  • Imogene Pieters,
  • Jade Logger,
  • Laura Sijben,
  • Maikel Peeters,
  • Mariël Teunissen,
  • Marije Blok-Hoos,
  • Marjolein Ketels,
  • Michiel Henkens,
  • Mireille Spanjers,
  • Monique Jacob-Dols,
  • Patrick de Hoogt,
  • Rik Houben,
  • Roos van Gorp,
  • Josien Jansen

DOI
https://doi.org/10.1136/bmjopen-2023-075232
Journal volume & issue
Vol. 13, no. 11

Abstract

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Objectives To evaluate the relationship among dysnatraemia at hospital presentation and duration of admission, risk of intensive care unit (ICU) admission and all-cause mortality and to assess the underlying pathophysiological mechanism of hyponatraemia in patients with COVID-19. Our hypothesis is that both hyponatraemia and hypernatraemia at presentation are associated with adverse outcomes.Design Observational study.Setting Secondary care; 11 Dutch hospitals (2 university and 9 general hospitals).Participants An analysis was performed within the retrospective multicentre cohort study COVIDPredict. 7811 patients were included (60% men, 40% women) between 24 February 2020 and 9 August 2022. Patients who were ≥18 years with PCR-confirmed COVID-19 or CT with COVID-19 reporting and data system score≥4 and alternative diagnosis were included. Patients were excluded when serum sodium levels at presentation were not registered in the database or when they had been transferred from another participating hospital.Outcome measures We studied demographics, medical history, symptoms and outcomes. Patients were stratified according to serum sodium concentration and urinary sodium excretion.Results Hyponatraemia was present in 2677 (34.2%) patients and hypernatraemia in 126 (1.6%) patients. Patients with hyponatraemia presented more frequently with diarrhoea, lower blood pressure and tachycardia. Hyponatraemia was, despite a higher risk for ICU admission (OR 1.27 (1.11–1.46; p<0.001)), not associated with mortality or the risk for intubation. Patients with hypernatraemia had higher mortality rates (OR 2.25 (1.49–3.41; p<0.001)) and were at risk for ICU admission (OR 2.89 (1.83–4.58)) and intubation (OR 2.95 (1.83–4.74)).Conclusions Hypernatraemia at presentation was associated with adverse outcomes in patients with COVID-19. Hypovolaemic hyponatraemia was found to be the most common aetiology of hyponatraemia. Hyponatraemia of unknown aetiology was associated with a higher risk for ICU admission and intubation and longer duration of admission.