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Prevalence and outcome of dysnatremia in patients with COVID-19 compared to controls.

与对照组相比,新型冠状病毒肺炎患者中不良钠血症的患病率和结局。

  • 影响因子:5.04
  • DOI:10.1530/EJE-20-1374
  • 作者列表:"Atila C","Sailer CO","Bassetti S","Tschudin-Sutter S","Bingisser R","Siegemund M","Osswald S","Rentsch K","Rueegg M","Schaerli S","Kuster GM","Twerenbold R","Christ-Crain M
  • 发表时间:2021-03-01
Abstract

Objective:The pandemic of coronavirus disease (COVID-19) has rapidly spread globally and infected millions of people. The prevalence and prognostic impact of dysnatremia in COVID-19 is inconclusive. Therefore, we investigated the prevalence and outcome of dysnatremia in COVID-19. Design:The prospective, observational, cohort study included consecutive patients with clinical suspicion of COVID-19 triaged to a Swiss Emergency Department between March and July 2020. Methods:Collected data included clinical, laboratory and disease severity scoring parameters on admission. COVID-19 cases were identified based on a positive nasopharyngeal swab test for SARS-CoV-2, patients with a negative swab test served as controls. The primary analysis was to assess the prognostic impact of dysnatremia on 30-day mortality using a cox proportional hazard model. Results:172 (17%) cases with COVID-19 and 849 (83%) controls were included. Patients with COVID-19 showed a higher prevalence of hyponatremia compared to controls (28.1% vs 17.5%, P < 0.001); while comparable for hypernatremia (2.9% vs 2.1%, P = 0.34). In COVID-19 but not in controls, hyponatremia was associated with a higher 30-day mortality (HR: 1.4, 95% CI: 1.10-16.62, P = 0.05). In both groups, hypernatremia on admission was associated with higher 30-day mortality (COVID-19 - HR: 11.5, 95% CI: 5.00-26.43, P < 0.001; controls - HR: 5.3, 95% CI: 1.60-17.64, P = 0.006). In both groups, hyponatremia and hypernatremia were significantly associated with adverse outcome, for example, intensive care unit admission, longer hospitalization and mechanical ventilation. Conclusion:Our results underline the importance of dysnatremia as predictive marker in COVID-19. Treating physicians should be aware of appropriate treatment measures to be taken for patients with COVID-19 and dysnatremia.

摘要

目的: 冠状病毒 (新型冠状病毒肺炎) 的大流行在全球迅速蔓延,并导致数百万人感染。新型冠状病毒肺炎患者的纳差患病率和预后影响尚无定论。因此,我们调查了新型冠状病毒肺炎患者的纳差患病率和结局。 设计: 前瞻性、观察性、队列研究包括在2020年3月至7月期间被分诊到瑞士急诊科的临床怀疑为新型冠状病毒肺炎的连续患者。 方法: 收集的数据包括入院时的临床、实验室和疾病严重程度评分参数。根据新型冠状病毒肺炎例鼻咽拭子检测阳性鉴定了SARS-CoV-2例,拭子检测阴性的患者作为对照。主要分析是使用cox比例风险模型来评估30天死亡率的预后影响。 结果: 共纳入172例 (17%) 病例,包括新型冠状病毒肺炎例和849例 (83%) 对照。与对照组相比,新型冠状病毒肺炎的患者显示出较高的低钠血症发生率 (28.1% vs 17.5%,P <0.001); 而高钠血症的发生率相当 (2.9% vs 2.1%,P = 0.34)。在新型冠状病毒肺炎中,但在对照组中,低钠血症与较高的30天死亡率相关 (HR: 1.4,95% CI: 1.10-16.62,P = 0.05)。在两组中,入院时高钠血症与较高的30天死亡率相关 (新型冠状病毒肺炎-HR: 11.5,95% CI: 5.00-26.43,P <0.001; 对照-HR: 5.3,95% CI: 1.60-17.64,P = 0.006)。在两组中,低钠血症和高钠血症与不良结果显著相关,例如,重症监护病房入院,更长的住院时间和机械通气。 结论: 我们的研究结果强调了作为新型冠状病毒肺炎预测指标的不良血钠的重要性。治疗医生应了解对新型冠状病毒肺炎和失钠血症患者应采取的适当治疗措施。

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