{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T18:39:15Z","timestamp":1763059155699,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T00:00:00Z","timestamp":1718928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection may cause acute respiratory failure, but also remains responsible for many other pathologies, including electrolyte disorders. SARS-CoV-2 infection causes disorders in many systems and can disrupt water homeostasis with thirst and appetite abnormalities. Dysnatremia affects prognosis, and may be associated with mortality in patients admitted to an intensive care unit (ICU) diagnosed with SARS-CoV-2. Materials and Methods: The study included 209 patients admitted to the ICU between 12 April 2021 and 1 March 2022 who were over 18 years old and diagnosed with SARS-CoV-2 infection by clinical and thoracic tomography findings or with a positive reverse transcription polymerase chain reaction (RT-PCR) test result. The laboratory markers, treatment modalities, nutritional, and respiratory support also for outcome evaluation, length of stay in the ICU, total hospitalization duration, and mortality in the ICU were recorded. The laboratory marker comparison was made using admission with the final assessment performed before the time of mortality in the ICU or after discharge. Results: Inotropic requirements among patients were high, which reflected mortality in the ICU. Hypernatremia presence was associated with an increase in enteral support, the inotropic support requirement, and mortality. Hypernatremia was correlated with diabetes mellitus, chronic renal failure, and a longer duration under mechanical ventilation. Conclusions: Hypernatremia was an important risk factor in ICU patients hospitalized for SARS-CoV-2 infection, which was also affected by the treatment regimens given themselves. This complex relationship underlies the importance of proper electrolyte management, especially in patients who were under severe stress and organ failure.<\/jats:p>","DOI":"10.3390\/medicina60071019","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T08:50:08Z","timestamp":1718959808000},"page":"1019","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dysnatremia as a Mortality Marker in Intensive Care Patients with SARS-CoV-2 Infection: A Retrospective Study"],"prefix":"10.3390","volume":"60","author":[{"given":"Guler","family":"Eraslan Doganay","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melek","family":"Doganci","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4441-6377","authenticated-orcid":false,"given":"Gulsah","family":"Yurtseven","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azra","family":"Ozanbarci","sequence":"additional","affiliation":[{"name":"Anesthesiology and Reanimation Intensive Care Unit, Ministry of Health Ankara Etlik City Hospital, 06170 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5397-8841","authenticated-orcid":false,"given":"Abdullah","family":"Kahraman","sequence":"additional","affiliation":[{"name":"Anesthesiology and Reanimation Intensive Care Unit, Ministry of Health Ankara Etlik City Hospital, 06170 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa Ozgur","family":"Cirik","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatma","family":"Ozturk Yalcin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1474-5591","authenticated-orcid":false,"given":"Seray","family":"Hazer","sequence":"additional","affiliation":[{"name":"Department of Thorasic Surgery, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerem","family":"Ensarioglu","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2022). COVID-19 Weekly Epidemiological Update Edition 76, WHO. Available online: https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20220125_weekly_epi_update_76.pdf?sfvrsn=b4fd8a15_13."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s11154-021-09627-3","article-title":"Management of hyponatraemia and hypernatraemia during the COVID-19 pandemic: A consensus statement of the Spanish Society for Endocrinology (Acqua Neuroendocrinology Group)","volume":"22","year":"2021","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1210\/clinem\/dgab107","article-title":"Dysnatremia is a predictor for morbidity and mortality in hospitalized patients with COVID-19","volume":"106","author":"Tzoulis","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1001\/jama.2020.6775","article-title":"Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area","volume":"323","author":"Richardson","year":"2020","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1177\/0004563220922255","article-title":"Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19)","volume":"57","author":"Lippi","year":"2020","journal-title":"Ann. Clin. Biochem."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1681\/ASN.2011080865","article-title":"Body fluid dynamics: Back to the future","volume":"22","author":"Bhave","year":"2011","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1038\/s41591-020-0968-3","article-title":"Extrapulmonary manifestations of COVID-19","volume":"26","author":"Gupta","year":"2020","journal-title":"Nat. Med."},{"key":"ref_9","first-page":"548","article-title":"Disnatremias y su asociaci\u00f3n con morbimortalidad en pacientes con COVID-19 [Dysnatremias and their association with morbidity and mortality in patients with COVID-19]","volume":"60","year":"2022","journal-title":"Rev. Med. Inst. Mex. Seguro. Soc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"666949","DOI":"10.3389\/fmed.2021.666949","article-title":"The Prognostic Value of Hyponatremia for Predicting Poor Outcome in Patients with COVID-19: A Systematic Review and Meta-Analysis","volume":"8","author":"Akbar","year":"2021","journal-title":"Front. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e565","DOI":"10.1002\/hsr2.565","article-title":"Hyponatremia in COVID-19 patients: Experience from Bangladesh","volume":"5","author":"Islam","year":"2022","journal-title":"Health Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1007\/s40620-021-01036-8","article-title":"Hyponatremia is associated with poor outcome in COVID-19","volume":"34","author":"Letellier","year":"2021","journal-title":"J. Nephrol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"So, B.Y.F., Wong, C.K., Chan, G.C.K., Ng, J.K.C., Lui, G.C.Y., Szeto, C.C., Hung, I.F.N., Tse, H.F., Tang, S.C.W., and Chan, T.M. (2023). Epidemiology and Outcomes of Hypernatraemia in Patients with COVID-19-A Territory-Wide Study in Hong Kong. J. Clin. Med., 12.","DOI":"10.3390\/jcm12031042"},{"key":"ref_14","first-page":"335","article-title":"Predictors of outcome in hospitalized patients with severe hyponatremia","volume":"95","author":"Nzerue","year":"2023","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.34067\/KID.0001062022","article-title":"Associations of Dysnatremia with COVID-19 Status and Mortality","volume":"3","author":"Liu","year":"2022","journal-title":"Kidney360"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"599255","DOI":"10.3389\/fendo.2020.599255","article-title":"Prognostic Impact of Hyponatraemia and Hypernatraemia in COVID-19 Pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) Registry Analysis","volume":"11","author":"Cuesta","year":"2020","journal-title":"Front. Endocrinol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1159\/000322238","article-title":"Hyponatremia and Inflammation: The Emerging Role of Interleukin-6 in Osmoregulation","volume":"118","author":"Swart","year":"2011","journal-title":"Nephron Physiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1111\/j.1460-9568.1995.tb00663.x","article-title":"Interleukin-1b Stimulates both Central and Peripheral Release of Vasopressin and Oxytocin in the Rat","volume":"7","author":"Landgraf","year":"1995","journal-title":"Eur. J. Neurosci."},{"key":"ref_19","first-page":"934","article-title":"Hypothalamic-pituitary-adrenal axis activation and stimulation of systemic vasopressin secretion by recombinant interleukin-6 in humans: Potential implications for the syndrome of inappropriate vasopressin secretion","volume":"79","author":"Mastorakos","year":"1994","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1007\/s40618-020-01301-w","article-title":"Hyponatremia, IL-6, and SARS-CoV-2 (COVID-19) infection: May all fit together?","volume":"43","author":"Berni","year":"2020","journal-title":"J. Endocrinol. Investig."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"o980","DOI":"10.1136\/bmj.o980","article-title":"When Hong Kong\u2019s \u201cdynamic zero\u201d COV\u0130D-19 strategy met omicron, low vaccination rates sent deaths soaring","volume":"377","author":"Ma","year":"2022","journal-title":"BMJ"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1038\/s41467-022-31395-0","article-title":"Contribution of low population immunity to the severe Omicron BA.2 outbreak in Hong Kong","volume":"13","author":"Chen","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.jcrc.2012.11.013","article-title":"Intensive care unit-acquired hypernatremia is an independent predictor of increased mortality and length of stay","volume":"28","author":"Waite","year":"2013","journal-title":"J. Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e0304","DOI":"10.1097\/CCE.0000000000000304","article-title":"Association between ICUacquired hypernatremia and in-hospital mortality: Data from the Medical Information Mart for Intensive Care III and the Electronic ICU Collaborative Research Database","volume":"2","author":"Olsen","year":"2020","journal-title":"Crit. Care Explor."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3109\/10715762.2015.1006216","article-title":"Role of angiotensin II and oxidative stress in renal inflammation by hypernatremia: Benefits of atrial natriuretic peptide, losartan, and tempol","volume":"49","author":"Roson","year":"2015","journal-title":"Free. Radic. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1515\/dx-2020-0046","article-title":"Clinical features, laboratory characteristics, and out comes of patients hospitalized with coronavirus disease 2019 (COVID-19): Early report from the United States","volume":"7","author":"Aggarwal","year":"2020","journal-title":"Diagnosis"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e01295","DOI":"10.1213\/XAA.0000000000001295","article-title":"Hypernatremia\u2014A manifestation of COVID-19: A case series","volume":"14","author":"Zimmer","year":"2020","journal-title":"AA Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/cen.13937","article-title":"Hyponatraemia in patients with community-acquired pneumonia; prevalence and aetiology, and natural history of SIAD","volume":"90","author":"Cuesta","year":"2019","journal-title":"Clin. Endocrinol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1111\/apt.15731","article-title":"Review article: Gastrointestinal features in COVID-19 and the possibility of faecal transmission","volume":"51","author":"Tian","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_30","first-page":"e9059","article-title":"Fluid replacement versus fluid restriction in COVID-19 associated hyponatremia. Cureus","volume":"12","author":"Khan","year":"2020","journal-title":"Cureus"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"E882","DOI":"10.1152\/ajpendo.00178.2020","article-title":"COVID-19 associated SIADH; a clue in the times of pandemic!","volume":"318","author":"Yousaf","year":"2020","journal-title":"Am. J. Physiol Endocrinol. Metab."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/7\/1019\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:02:26Z","timestamp":1760108546000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/7\/1019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,21]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["medicina60071019"],"URL":"https:\/\/doi.org\/10.3390\/medicina60071019","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2024,6,21]]}}}