medigraphic.com
ISSN 2448-8909 (Print)

2021, Number 4

<< Back Next >>

Med Crit 2021; 35 (4)

Hyponatremia and lung injury: a dangerous association in SARS-CoV-2?

Ledesma CL, Sánchez DJS, Peniche MKG, Monares ZE, González EEA, Calyeca SMV

Language: Spanish
References: 19
Page: 172-175
PDF size: 234.04 Kb.


ABSTRACT

Introduction: The SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) pandemic has become a milestone in the modern history of mankind, severe pneumonia that causes high levels of IL-6 which stimulates the hypothalamus For antidiuretic hormone secretion and condition hyponatremia (serum Na + < 135 mEq/L), this occurs in 29% of patients diagnosed with pneumonia and is considered a marker of inflammation, severity and prognosis. Material and methods: Ambispective, descriptive, analytical cohort study that included patients with a diagnosis of severe pneumonia due to SARS-CoV-2; they were classified into two groups: group 1 (G1) without hyponatremia and group 2 (G2) with hyponatremia, an association was identified between lung injury. Results: 53 patients were included, G1 included 37 (69.8%) and G2 16 (30.2%) patients, the mean sodium (Na+) was 139.86 ± 3.55 and 130 ± 3.29 for G1 and G2 respectively (p = 0.001). Of the pulmonary variables, PaO2/FiO2 was 85.73 ± 29.93 and 114 ± 57.37 mmHg, static compliance of 34.67 ± 8.99 and 31.87 ± 10.89 cmH2O, for G1 and G2 respectively. Mortality in G1 was 42% and 75% in G2 with OR Sodium-Mortality 3.93 (95% CI 1.06-14.52), p = 0.03. Conclusion: Lower serum Na + concentrations are associated with greater severity and worse outcomes in patients with severe SARS-CoV-2 pneumonia. Making the measurement of serum sodium a feasible quantification resource to associate it with the severity of lung injury due to SARS-CoV-2 and to identify patients with a higher risk of complications and death.


REFERENCES

  1. Letko M, Munster V. Functional assessment of cell entry and receptor usage for lineage B β-coronaviruses, including 2019-nCoV. Nature Microbiology. doi: 10.1101/2020.01.22.915660.

  2. Hu B, Guo H, Zhou P, et al. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2020;1-14. doi: 10.1038/s41579-020-00459-7.

  3. Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol. 2019;17:181-192. doi: 10.1038/s41579-018-0118-9.

  4. Han Q, Lin Q, Jin S, You L. Coronavirus 2019-nCoV: a brief perspective from the front line. J Infect. 2020;80(4):373-377. doi: 10.1016/j.jinf.2020.02.010.

  5. Mehta P, McAuley D, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-1034. doi: 10.1016/S0140-6736(20)30628-0.

  6. Yang L, Liu S, Liu J, et al. COVID-19: immunopathogenesis and immunotherapeutics. Signal Transduction and Targeted Therapy. 2020:128. doi: org/10.1038/s41392-020-00243-2.

  7. Stukas S, Hoiland R, Cooper J, et al. The association of inflammatory cytokines in the pulmonary pathophysiology of respiratory failure in critically ill patients with coronavirus disease 2019. Crit Care Expl. 2020;2:e0203. doi: 10.1097/CCE.0000000000000203.

  8. Aziz M, Aziz M, Fatima R, et al. Elevated interleukin-6 and severe COVID-19: a meta-analysis. J Med Virol. 2020;92:2283-2285.

  9. Habib MB, Sardar S, Sajid J. Acute symptomatic hyponatremia in setting of SIADH as an isolated presentation of COVID-19. IDCases. 2020;21:e00859. doi: 10.1016/j.idcr.2020.e00859.

  10. Edmonds ZV. Hyponatremia in pneumonia. J Hosp Med. 2012;7 Suppl 4:S11-S13. doi: 10.1002/jhm.1933.

  11. Swart RM, Hoorn EJ, Betjes MG, Zietse R. Hyponatremia and inflammation: the emerging role of interleukin-6 in osmoregulation. Nephron Physiol. 2011;118(2):45-51. doi: 10.1159/000322238.

  12. Kox M, Waalders NJB, Kooistra EJ, Gerretsen J, Pickkers P. Cytokine levels in critically ill patients with COVID-19 and other conditions. JAMA. 2020;324(15):1565-1567. doi: 10.1001/jama.2020.17052.

  13. Aggarwal S, Garcia-Telles N, Aggarwal G, Lavie C, Lippi G, Henry BM. Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): early report from the United States. Diagnosis. 2020;7:91-96. doi: 10.1515/dx-2020-0046.

  14. Yousaf Z, Al-Shokri SD, Al-Soub H, Mohamed MFH. COVID-19-associated SIADH: a clue in the times of pandemic! Am J Physiol Endocrinol Metab. 2020;318(6):E882-E885. doi: 10.1152/ajpendo.00178.2020.

  15. Sheikh M, Ahmad E, Jeelani H, et al. COVID-19 pneumonia: an emerging cause of syndrome of inappropriate antidiuretic hormone. Cureus. 2020;12(6):e8841. doi: 10.7759/cureus.8841.

  16. Khalangot M. COVID-19 and SIADH relations: impact of the positive pressure ventilation. Am J Physiol Endocrinol Metab. 2020;319(1):E196. doi: 10.1152/ajpendo.00288.2020.

  17. Berni A., Malandrino D., Parenti, G, et al. Hyponatremia, IL-6, and SARS-CoV-2 (COVID-19) infection: may all fit together? J Endocrinol Invest. 2020:1137-1139. doi: org/10.1007/s40618-020-01301-w.

  18. Królicka AL, Kruczkowska A, Krajewska M, Kusztal MA. Hyponatremia in infectious diseases-a literature review. Int J Environ Res Public Health. 2020;17(15):5320. doi: 10.3390/ijerph17155320.

  19. Lippi G, South AM, Henry BM. Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Ann Clin Biochem. 2020;57(3):262-265. doi: 10.1177/0004563220922255.




2020     |     www.medigraphic.com