Critical Care and Shock

Electrolyte imbalance and clinical outcomes in hospitalized COVID-19 patients

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Purpose: Electrolyte imbalance is associated with increased morbidity and mortality among critically ill coronavirus disease 2019 (COVID-19) patients. This study aimed to investigate the role of specific electrolytes in influencing patient outcomes.

Methods: Retrospective analysis of COVID-19 patients who were admitted to a single center in Houston, Texas, between March 2020 and February 2022. Patients were divided into Group 1 (balanced electrolytes) and Group 2 (imbalanced electrolytes). Prevalence and outcomes of electrolyte disorders were analyzed. We defined electrolyte imbalances as sodium<135 mEq/l or sodium>145 mEq/l, or potassium<3.5 mEq/l or potassium>5.2 mEq/l, or chloride<98 mEq/l or chloride>108 mEq/l, or magnesium<1.7 mg/dl or magnesium>2.2 mg/dl, or phosphorus<2.8 mg/dl or phosphorus>4.5 mg/dl, or calcium<8.6 mg/dl or calcium>10.3 mg/dl. Data was assessed using IBM SPSS™ Statistics version 24.0 and employing descriptive statistics and chi-square tests to ascertain statistical significance.

Results: A total of 953 patients were included in this analysis. The median age was 56 years (44-67), and 541 (56%) were men. The median hospitalization duration was 7 days (4-12). One hundred and seventy-nine patients (18.7%) died. The median level of sodium was 136 (133-138), potassium 3.9 (3.6-4.3), chloride 101 (98-104), calcium 8.6 (8.2-9), phosphorus 3.1 (2.6-3.7), and magnesium 2 (1.8-2.2). Ninety-four (16.5%) patients without sodium imbalance and 85 (22.2%) with sodium imbalance died (p=0.027). One hundred twenty-two (16.4%) patients without chloride imbalance and 57 (27.5%) with chloride imbalance died (p<0.001). For potassium, 153 (19.3%) patients without an imbalance died and 26 (16.1%) with an imbalance died (p=0.348). Sixty-seven (13.4%) patients without calcium imbalance and 112 (24.8%) with an imbalance died (p<0.001). Ninety-six (15.9%) without phosphorus imbalance and 83 (23.9%) patients with imbalance died (p=0.002). One hundred eleven (17%) patients without magnesium imbalance and 68 (22.7%) with imbalance died (p=0.037).

Conclusions: Sodium, chloride, calcium, and phosphorus imbalances were significantly associated with higher mortality rates in COVID-19 patients. In this cohort, potassium and magnesium imbalances did not exhibit statistically significant differences in mortality rates.

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