{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T22:04:23Z","timestamp":1781129063060,"version":"3.54.1"},"reference-count":80,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,4]]},"abstract":"<jats:p>Background: The World Health Organization declared the coronavirus disease-2019 (COVID-19) a pandemic in December 2019. COVID-19 can affect most organs of the body but predominantly affects the lungs. Chest infection is associated with hyponatremia primarily due to inappropriate ectopic secretion of antidiuretic hormone. We conducted a six-month retrospective observational study to evaluate the relationship between chest X-ray (CXR) radiological findings and serum sodium levels. Our secondary goal was to assess the relationship between CXR findings and patient outcomes.<\/jats:p>\n                  <jats:p>Aim of the Study: To assess the relationship between the initial CXR findings, hyponatremia severity, and outcome in COVID-19 infected patients.<\/jats:p>\n                  <jats:p>\n                    Materials and methods: We conducted a retrospective review of CXR findings of COVID-19 patients aged &gt; 18 years. The patients were healthy and had no history of hyponatremia before COVID-19 infection. All recruited patients were admitted to one of four hospitals in Qatar (Hazm Mebaireek General Hospital, Communicable Disease Center, and all affiliated quarantine centers managed under the Communicable Disease Centre, Mesaieed Hospital, and Ras Laffan Hospital) between March and June 2020. We excluded patients with factors that contributed to hyponatremia. Three score grades were established to describe the CXR findings. Patients were divided into three groups by the principal researcher according to their serum sodium levels. A radiologist evaluated the CXR findings with the patient and group information obscured. The principal researcher collected the X-ray scores for analysis with the serum sodium levels. We used SPSS for Windows, Version 15.0. (SPSS Inc., Chicago, IL, USA) and STATA Package Version 12.0 (StataCorp, College Station, TX, USA) to analyze the data. A\n                    <jats:italic>p<\/jats:italic>\n                    -value \u2264\u00a0 0.05 was considered significant.\n                  <\/jats:p>\n                  <jats:p>\n                    Results: A total of 414 CXR patients with COVID-19 were recruited; 275 patients had hyponatremia and 139 had normal sodium levels and were used as the control group. Patients with normal serum sodium and hyponatremia were classified into three categories based on the CXR findings. Grade 0 (95), Grade 1 (43), and Grade 2 (137) hyponatremic patients were reported. The mean sodium levels were 133.6, 131.3, and 127.2 mmol\/L for Grades 0, 1, and 2, respectively (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0&lt;\u00a00.001). More than 95% of the patients who developed hyponatremia were &gt;30 years. Moderate and severe hyponatremia was more prevalent in patients with Grade 1 or Grade 2 CXR findings and were &gt;30 years.\n                  <\/jats:p>\n                  <jats:p>Conclusion: Serum sodium levels in COVID-19 patients correlated well with the severity of the CXR findings observed at the early disease stage. Furthermore, simple CXR scores can be used to identify COVID-19 patients at a higher risk of hyponatremia, length of hospital stay, medical care support type, and mortality.<\/jats:p>","DOI":"10.5339\/qmj.2022.34","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T10:30:33Z","timestamp":1659695433000},"source":"Crossref","is-referenced-by-count":4,"title":["Chest X-ray Findings and Hyponatremia in COVID-19 Pneumonia Patients"],"prefix":"10.5339","volume":"2022","author":[{"given":"Elmukhtar","family":"Habas","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar E-mail: faidhramzee@live.com"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdussalam","family":"Abugrara Said","sequence":"additional","affiliation":[{"name":"Department of Radiology, Al-Rumailah Hospital, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Faidh Ramzee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafedh","family":"Ghazouani","sequence":"additional","affiliation":[{"name":"Department of Statistics, Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areen","family":"Fino","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad A.","family":"Abu Khattab","sequence":"additional","affiliation":[{"name":"Communicable Disease Center (CDC), Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muna S.","family":"Al Masalamani","sequence":"additional","affiliation":[{"name":"Communicable Disease Center (CDC), Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Prabhakaran Nair","sequence":"additional","affiliation":[{"name":"Communicable Disease Center (CDC), Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"key":"CIT0001","article-title":"Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) [Internet]"},{"issue":"395:","key":"CIT0002","series-title":"Lancet.","first-page":"1225\u20131228.","article-title":"COVID-19 and Italy: what next?.","year":"2020"},{"key":"CIT0003","series-title":"medRxiv.","article-title":"Low blood sodium increases risk and severity of COVID-19: a systematic review, meta-analysis and retrospective cohort study.","year":"2020"},{"issue":"12:","key":"CIT0004","series-title":"Cureus","first-page":"e9059","article-title":"Fluid replacement versus fluid restriction in COVID-19 associated hyponatremia.","year":"2020,"},{"issue":"6:","key":"CIT0005","series-title":"J Clin Nephrol Ren Care.","first-page":"57","article-title":"Hyponatremia in COVID-19 infection-should only think about SIADH.","year":"2020"},{"issue":"57:","key":"CIT0006","series-title":"Medicina (Kaunas).","first-page":"55","article-title":"Is there a relationship between COVID-19 and hyponatremia?.","year":"2021"},{"issue":"85:","key":"CIT0007","series-title":"Polish J Radiol.","first-page":"e361\u2013e368","article-title":"COVID-19 severity scoring systems in radiological imaging \u2013 a review.","year":"2020"},{"issue":"296:","key":"CIT0008","series-title":"Radiology.","first-page":"E97\u2013E104","article-title":"CO-RADS: a categorical CT assessment scheme for patients suspected of having COVID-19-definition and evaluation.","year":"2020,"},{"issue":"43:","key":"CIT0009","series-title":"J Endocrinol Invest.","first-page":"1137\u20131139","article-title":"Hyponatremia, IL-6, and SARS-CoV-2 (COVID-19) infection: may all fit together?.","year":"2020,"},{"issue":"(7):","key":"CIT0010","series-title":"Quant Imaging Med Surg","first-page":"1540\u20131550","article-title":"Clinical utility of chest radiography for severe COVID-19.","volume":"10","year":"2020"},{"issue":"125:","key":"CIT0011","series-title":"Radiol Med.","first-page":"461\u2013464","article-title":"Radiographic severity index in COVID-19 pneumonia: relationship to age and sex in 783 Italian patients.","year":"2020"},{"issue":"54:","key":"CIT0012","series-title":"Eur Resp J.","first-page":"OA3299","article-title":"The radiographic assessment of lung edema [RALE] score has excellent diagnostic accuracy for ARDS.","year":"2019,"},{"issue":"11:","key":"CIT0013","series-title":"J Clin Imaging Sci.","first-page":"9","article-title":"CO-RADS: coronavirus classification review.","year":"2021,"},{"issue":"296:","key":"CIT0014","series-title":"Radiology.","first-page":"E72\u2013E78","article-title":"Frequency and distribution of chest radiographic findings in patients positive for COVID-19.","year":"2020,"},{"issue":"15:","key":"CIT0015","series-title":"BMC Med Imaging","first-page":"61","article-title":"A\u00a0chest radiograph scoring system in patients with severe acute respiratory infection: a\u00a0validation study.","year":"2015,"},{"issue":"21:","key":"CIT0016","series-title":"Korean J Radiol.","first-page":"494\u2013500","article-title":"Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea.","year":"2020;"},{"issue":"(5):","key":"CIT0017","series-title":"Radiol Med.","first-page":"509\u2013513","article-title":"COVID-19 outbreak in Italy: experimental chest X-ray scoring system for quantifying and monitoring disease progression.","volume":"125","year":"2020"},{"issue":"29:","key":"CIT0018","series-title":"Nephrol Dial Transplant.","first-page":"i1\u2013i39","article-title":"Clinical practice guideline on diagnosis and treatment of hyponatraemia.","year":"2014,"},{"issue":"139:","key":"CIT0019","series-title":"Ann Intern Med.","first-page":"715\u2013723","article-title":"Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong.","year":"2003,"},{"issue":"68:","key":"CIT0020","series-title":"Endocrine.","first-page":"251\u2013252","article-title":"COVID-19, hypothalamo-pituitary-adrenal axis and clinical implications.","year":"2020,"},{"issue":"97:","key":"CIT0021","series-title":"Kidney Int.","first-page":"1091\u20131093","article-title":"Blockade of SARS-CoV-2 infection by recombinant soluble ACE2.","year":"2020,"},{"issue":"98:","key":"CIT0022","series-title":"Kidney Int.","first-page":"219\u2013227","article-title":"Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China","year":"2020,"},{"issue":"356:","key":"CIT0023","series-title":"N Engl J Med.","first-page":"2064\u20132072","article-title":"Clinical practice. The syndrome of inappropriate antidiuresis.","year":"2007,"},{"issue":"13:","key":"CIT0024","series-title":"Clin Kidney J.","first-page":"461\u2013462","article-title":"The syndrome of inappropriate antidiuresis in COVID-19 pneumonia: report of two cases.","year":"2020,"},{"issue":"31:","key":"CIT0025","series-title":"J Am Soc Nephrol.","first-page":"1380\u20131383","article-title":"Acute kidney injury in COVID-19: emerging evidence of a distinct pathophysiology.","year":"2020,"},{"issue":"13:","key":"CIT0026","series-title":"BMJ Case Rep.","first-page":"e235456","article-title":"COVID-19 presenting with diarrhoea and hyponatraemia.","year":"2020,"},{"issue":"1:","key":"CIT0027","series-title":"J Allergy Infect Dis.","first-page":"53\u201356","article-title":"Hyponatremia in COVID-19 infection: possible causal factors and management.","year":"2020,"},{"issue":"80:","key":"CIT0028","series-title":"Kidney Int.","first-page":"708\u2013718","article-title":"TWEAK, a multifunctional cytokine in kidney injury.","year":"2011,"},{"issue":"52:","key":"CIT0029","series-title":"Egypt J Radiol Nucl Med.","first-page":"38","article-title":"COVID-19 pneumonia: a pictorial review of CT findings and differential diagnosis.","year":"2021,"},{"issue":"302:","key":"CIT0030","series-title":"Radiology","first-page":"460\u2013469","article-title":"Chest radiograph scoring alone or combined with other risk scores for predicting outcomes in COVID-19.","year":"2022,"},{"issue":"11:","key":"CIT0031","series-title":"Front Endocrinol (Lausanne).","first-page":"599255","article-title":"Prognostic impact of hyponatremia and hypernatremia in COVID-19 pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) registry analysis.","year":"2020,"},{"issue":"395:","key":"CIT0032","series-title":"Lancet","first-page":"507\u2013513","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.","year":"2020,"},{"issue":"99:","key":"CIT0033","series-title":"Ann Hematol.","first-page":"1205\u20131208","article-title":"Mechanism of thrombocytopenia in COVID-19 patients.","year":"2020,"},{"issue":"(5):","key":"CIT0034","series-title":"Cell.","first-page":"551\u201361","article-title":"Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia.","volume":"106","year":"2001"},{"issue":"96:","key":"CIT0035","series-title":"Int J Infect Dis.","first-page":"467\u2013474","article-title":"Association of inflammatory markers with the severity of COVID-19: A meta-analysis.","year":"2020,"},{"issue":"27:","key":"CIT0036","series-title":"Cell Host Microbe.","first-page":"992-1000.e3","article-title":"Complex immune dysregulation in COVID-19 patients with severe respiratory failure.","year":"2020,"},{"issue":"9:","key":"CIT0037","series-title":"Emerg Microbes Infect.","first-page":"1123\u20131130","article-title":"Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors.","year":"2020,"},{"issue":"57:","key":"CIT0038","series-title":"Ann Clin Biochem.","first-page":"262\u2013265","article-title":"Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19).","year":"2020,"},{"issue":"25:","key":"CIT0039","series-title":"Clin Exp Nephrol.","first-page":"401\u2013409","article-title":"Hypokalemia in patients with COVID-19.","year":"2021,"},{"key":"CIT0040","article-title":"2022 [Accessed 3rd June 2022]"},{"key":"CIT0001","article-title":"Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) [Internet]"},{"issue":"395:","key":"CIT0002","series-title":"Lancet.","first-page":"1225\u20131228.","article-title":"COVID-19 and Italy: what next?.","year":"2020"},{"key":"CIT0003","series-title":"medRxiv.","article-title":"Low blood sodium increases risk and severity of COVID-19: a systematic review, meta-analysis and retrospective cohort study.","year":"2020"},{"issue":"12:","key":"CIT0004","series-title":"Cureus","first-page":"e9059","article-title":"Fluid replacement versus fluid restriction in COVID-19 associated hyponatremia.","year":"2020,"},{"issue":"6:","key":"CIT0005","series-title":"J Clin Nephrol Ren Care.","first-page":"57","article-title":"Hyponatremia in COVID-19 infection-should only think about SIADH.","year":"2020"},{"issue":"57:","key":"CIT0006","series-title":"Medicina (Kaunas).","first-page":"55","article-title":"Is there a relationship between COVID-19 and hyponatremia?.","year":"2021"},{"issue":"85:","key":"CIT0007","series-title":"Polish J Radiol.","first-page":"e361\u2013e368","article-title":"COVID-19 severity scoring systems in radiological imaging \u2013 a review.","year":"2020"},{"issue":"296:","key":"CIT0008","series-title":"Radiology.","first-page":"E97\u2013E104","article-title":"CO-RADS: a categorical CT assessment scheme for patients suspected of having COVID-19-definition and evaluation.","year":"2020,"},{"issue":"43:","key":"CIT0009","series-title":"J Endocrinol Invest.","first-page":"1137\u20131139","article-title":"Hyponatremia, IL-6, and SARS-CoV-2 (COVID-19) infection: may all fit together?.","year":"2020,"},{"issue":"(7):","key":"CIT0010","series-title":"Quant Imaging Med Surg","first-page":"1540\u20131550","article-title":"Clinical utility of chest radiography for severe COVID-19.","volume":"10","year":"2020"},{"issue":"125:","key":"CIT0011","series-title":"Radiol Med.","first-page":"461\u2013464","article-title":"Radiographic severity index in COVID-19 pneumonia: relationship to age and sex in 783 Italian patients.","year":"2020"},{"issue":"54:","key":"CIT0012","series-title":"Eur Resp J.","first-page":"OA3299","article-title":"The radiographic assessment of lung edema [RALE] score has excellent diagnostic accuracy for ARDS.","year":"2019,"},{"issue":"11:","key":"CIT0013","series-title":"J Clin Imaging Sci.","first-page":"9","article-title":"CO-RADS: coronavirus classification review.","year":"2021,"},{"issue":"296:","key":"CIT0014","series-title":"Radiology.","first-page":"E72\u2013E78","article-title":"Frequency and distribution of chest radiographic findings in patients positive for COVID-19.","year":"2020,"},{"issue":"15:","key":"CIT0015","series-title":"BMC Med Imaging","first-page":"61","article-title":"A\u00a0chest radiograph scoring system in patients with severe acute respiratory infection: a\u00a0validation study.","year":"2015,"},{"issue":"21:","key":"CIT0016","series-title":"Korean J Radiol.","first-page":"494\u2013500","article-title":"Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea.","year":"2020;"},{"issue":"(5):","key":"CIT0017","series-title":"Radiol Med.","first-page":"509\u2013513","article-title":"COVID-19 outbreak in Italy: experimental chest X-ray scoring system for quantifying and monitoring disease progression.","volume":"125","year":"2020"},{"issue":"29:","key":"CIT0018","series-title":"Nephrol Dial Transplant.","first-page":"i1\u2013i39","article-title":"Clinical practice guideline on diagnosis and treatment of hyponatraemia.","year":"2014,"},{"issue":"139:","key":"CIT0019","series-title":"Ann Intern Med.","first-page":"715\u2013723","article-title":"Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong.","year":"2003,"},{"issue":"68:","key":"CIT0020","series-title":"Endocrine.","first-page":"251\u2013252","article-title":"COVID-19, hypothalamo-pituitary-adrenal axis and clinical implications.","year":"2020,"},{"issue":"97:","key":"CIT0021","series-title":"Kidney Int.","first-page":"1091\u20131093","article-title":"Blockade of SARS-CoV-2 infection by recombinant soluble ACE2.","year":"2020,"},{"issue":"98:","key":"CIT0022","series-title":"Kidney Int.","first-page":"219\u2013227","article-title":"Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China","year":"2020,"},{"issue":"356:","key":"CIT0023","series-title":"N Engl J Med.","first-page":"2064\u20132072","article-title":"Clinical practice. The syndrome of inappropriate antidiuresis.","year":"2007,"},{"issue":"13:","key":"CIT0024","series-title":"Clin Kidney J.","first-page":"461\u2013462","article-title":"The syndrome of inappropriate antidiuresis in COVID-19 pneumonia: report of two cases.","year":"2020,"},{"issue":"31:","key":"CIT0025","series-title":"J Am Soc Nephrol.","first-page":"1380\u20131383","article-title":"Acute kidney injury in COVID-19: emerging evidence of a distinct pathophysiology.","year":"2020,"},{"issue":"13:","key":"CIT0026","series-title":"BMJ Case Rep.","first-page":"e235456","article-title":"COVID-19 presenting with diarrhoea and hyponatraemia.","year":"2020,"},{"issue":"1:","key":"CIT0027","series-title":"J Allergy Infect Dis.","first-page":"53\u201356","article-title":"Hyponatremia in COVID-19 infection: possible causal factors and management.","year":"2020,"},{"issue":"80:","key":"CIT0028","series-title":"Kidney Int.","first-page":"708\u2013718","article-title":"TWEAK, a multifunctional cytokine in kidney injury.","year":"2011,"},{"issue":"52:","key":"CIT0029","series-title":"Egypt J Radiol Nucl Med.","first-page":"38","article-title":"COVID-19 pneumonia: a pictorial review of CT findings and differential diagnosis.","year":"2021,"},{"issue":"302:","key":"CIT0030","series-title":"Radiology","first-page":"460\u2013469","article-title":"Chest radiograph scoring alone or combined with other risk scores for predicting outcomes in COVID-19.","year":"2022,"},{"issue":"11:","key":"CIT0031","series-title":"Front Endocrinol (Lausanne).","first-page":"599255","article-title":"Prognostic impact of hyponatremia and hypernatremia in COVID-19 pneumonia. A HOPE-COVID-19 (Health Outcome Predictive Evaluation for COVID-19) registry analysis.","year":"2020,"},{"issue":"395:","key":"CIT0032","series-title":"Lancet","first-page":"507\u2013513","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.","year":"2020,"},{"issue":"99:","key":"CIT0033","series-title":"Ann Hematol.","first-page":"1205\u20131208","article-title":"Mechanism of thrombocytopenia in COVID-19 patients.","year":"2020,"},{"issue":"(5):","key":"CIT0034","series-title":"Cell.","first-page":"551\u201361","article-title":"Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia.","volume":"106","year":"2001"},{"issue":"96:","key":"CIT0035","series-title":"Int J Infect Dis.","first-page":"467\u2013474","article-title":"Association of inflammatory markers with the severity of COVID-19: A meta-analysis.","year":"2020,"},{"issue":"27:","key":"CIT0036","series-title":"Cell Host Microbe.","first-page":"992-1000.e3","article-title":"Complex immune dysregulation in COVID-19 patients with severe respiratory failure.","year":"2020,"},{"issue":"9:","key":"CIT0037","series-title":"Emerg Microbes Infect.","first-page":"1123\u20131130","article-title":"Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors.","year":"2020,"},{"issue":"57:","key":"CIT0038","series-title":"Ann Clin Biochem.","first-page":"262\u2013265","article-title":"Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19).","year":"2020,"},{"issue":"25:","key":"CIT0039","series-title":"Clin Exp Nephrol.","first-page":"401\u2013409","article-title":"Hypokalemia in patients with COVID-19.","year":"2021,"},{"key":"CIT0040","article-title":"2022 [Accessed 3rd June 2022]"}],"container-title":["Qatar Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2022\/3\/article-34.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2022\/3\/article-34.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2022\/3\/article-34.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:10:37Z","timestamp":1777309837000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2022\/3\/article-34.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,4]]},"references-count":80,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.5339\/qmj.2022.34","relation":{},"ISSN":["2227-0426"],"issn-type":[{"value":"2227-0426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,4]]}}}