Prevalence and outcomes of hyponatremia among COVID-19 patients: A systematic review and meta-analysis

Reem Jamal Yousif Khidir; Basil Abubakr Yagoub Ibrahim; Mosab Hussen Mostafa Adam; Riyan Mobark Elsiddig Hassan; Amro Suliman Salih Fedail; Rabab Osman Abdulhamid; Sagad Omer Obeid Mohamed

Prevalence and outcomes of hyponatremia among COVID-19 patients: A systematic review and meta-analysis

Int J Health Sci (Qassim). 2022 Sep-Oct;16(5):69-84.

Authors

Reem Jamal Yousif Khidir¹, Basil Abubakr Yagoub Ibrahim¹, Mosab Hussen Mostafa Adam¹, Riyan Mobark Elsiddig Hassan¹, Amro Suliman Salih Fedail¹, Rabab Osman Abdulhamid¹, Sagad Omer Obeid Mohamed¹

Affiliation

¹ Department of Internal Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.

PMID: 36101848
PMCID: PMC9441642

Abstract

Objectives: On March 2020, the WHO declared coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is associated with various clinical syndromes, with electrolytes imbalances involved. This review aims to quantify the prevalence and outcomes of hyponatremia among COVID-19 patients, as well as to review the underlying pathophysiological mechanisms of hyponatremia among these patients.

Methods: Using Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, we conducted a systematic literature search using the electronic databases of Google Scholar, MEDLINE (PubMed), WHO Virtual Health Library, and ScienceDirect, without limitations regarding gender, geographical area, race or publication date, up until December 13, 2021. Primary outcomes measured were mortality, intensive care unit (ICU) admission, assisted ventilation need, and length of hospital stay (LOS). Secondary outcome was the mechanism underlying hyponatremia among COVID-19 patients.

Results: From a total of 52 included studies, 23 underwent quantitative analysis. For the primary outcomes; proportions, odds ratios (OR), and standardized mean difference (SMD) were calculated using random effects model. The prevalence of hyponatremia was found to be 25.8%. Hyponatremia was found to be significantly associated with increased odds for mortality (OR = 1.97[95% CI, 1.50-2.59]), ICU admission (OR = 1.91 [95% CI, 1.56-2.35]), assisted ventilation need (OR = 2.04 [95% CI, 1.73-2.38]), and with increased LOS (SMD of 5.74 h [95% CI, 0.092-0.385]). Regarding the mechanisms underlying hyponatremia, syndrome of inappropriate anti-diuretic hormone secretion (SIADH) was most commonly reported, followed by adrenal insufficiency, and finally hypovolemic hyponatremia due to gastrointestinal losses.

Conclusion: Hyponatremia among COVID-19 patients is generally associated with poor outcomes, with SIADH being the most common underlying mechanism.

Keywords: Adverse outcomes; COVID-19; hyponatremia; prevalence.

Publication types

Review