Implicaciones clínicas de las disnatremias y su relación con la mortalidad en pacientes adultos críticamente enfermos con covid-19 durante el año 2021
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Fecha
2024
Autores
Echeverri Muñoz, Diana Marcela
Rojas Moreno, Heiner José
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Ediciones Universidad Simón Bolívar
Facultad Ciencias de la Salud
Facultad Ciencias de la Salud
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Introducción: Los trastornos del sodio son alteraciones electrolíticas frecuentes en los pacientes críticamente enfermos y puede presentarse con hiponatremia e hipernatremia. En pacientes con COVID-19 las disnatremias se asocia con un peor desenlace de morbimortalidad. Objetivos: Dilucidar las implicaciones clínicas de las disnatremias y su relación con la mortalidad durante la estancia hospitalaria en pacientes adultos con COVID-19 críticamente enfermos. Materiales y métodos: Analítico correlacional, retrospectivo. Se incluyeron pacientes adultos positivos para SARS-CoV-2, ingresados a cuidados intensivos en Barranquilla (Colombia) entre enero y diciembre del año 2021. Los pacientes se dividieron según la presencia y el tipo de disnatremia (normonatrémicos, hiponatrémicos e hipernatrémicos). Los datos se evaluaron mediante regresión logística univariada. La mortalidad se determinó a través de cocientes de riesgos instantáneo (HR) con sus intervalos de confianza al 95%. Resultados: Se incluyeron 185 pacientes. La prevalencia de disnatremia fue 24.9%: 17 con hiponatremia (9.2%) y 29 con hipernatremia (15.7%). Los pacientes con disnatremia padecían con mayor frecuencia de enfermedad renal crónica (23.8%), requerimiento de terapia reemplazo renal (25.9%), y niveles elevados de creatinina, ferritina y nitrógeno ureico sérico. La presencia de hipernatremia en la admisión influyó en un riesgo mayor de muerte en comparación con la normonatremia (HR = 1.73: IC 95% [1.12 – 2.68]; p = 0.013). Conclusiones: La presencia de hipernatremia en la admisión influyó en la supervivencia en comparación con la normonatremia. Además, los pacientes disnatrémicos padecían con mayor frecuencia de enfermedad renal crónica, necesidad de terapia de reemplazo renal, y niveles elevados de creatinina, ferritina y nitrógeno ureico.
Introduction: Sodium disorders are common electrolyte disturbances in critically ill patients and can present with hyponatremia and hypernatremia. In patients with COVID-19, dysnatremia is associated with a worse morbidity and mortality outcome. Objectives: To elucidate the clinical implications of dysnatremia and its relationship with mortality during hospital stay in critically ill adult patients with COVID-19. Materials and Methods: Correlational, retrospective analysis. Adult patients positive for SARS-CoV-2, admitted to intensive care in Barranquilla (Colombia) between January and December 2021, were included. Patients were divided according to the presence and type of dysnatremia (normonatremia, hyponatremic and hypernatremic). Data were evaluated using univariate logistic regression. Mortality was determined through hazard ratios (HR) with 95% confidence intervals. Results: 185 patients were included. The prevalence of dysnatremia was 24.9%: 17 with hyponatremia (9.2%) and 29 with hypernatremia (15.7%). Patients with dysnatremia more frequently suffered from chronic kidney disease (23.8%), requiring renal replacement therapy (25.9%), and elevated levels of creatinine, ferritin, and serum urea nitrogen. The presence of hypernatremia on admission influences a higher risk of death compared to normonatremic (HR = 1.73: 95% CI [1.12 – 2.68]; p = 0.013). Conclusions: The presence of hypernatremia on admission influenced survival compared to normonatremia. Furthermore, dysnatremic patients more frequently suffered from chronic kidney disease, need for renal replacement therapy, and elevated levels of creatinine, ferritin, and urea nitrogen.
Introduction: Sodium disorders are common electrolyte disturbances in critically ill patients and can present with hyponatremia and hypernatremia. In patients with COVID-19, dysnatremia is associated with a worse morbidity and mortality outcome. Objectives: To elucidate the clinical implications of dysnatremia and its relationship with mortality during hospital stay in critically ill adult patients with COVID-19. Materials and Methods: Correlational, retrospective analysis. Adult patients positive for SARS-CoV-2, admitted to intensive care in Barranquilla (Colombia) between January and December 2021, were included. Patients were divided according to the presence and type of dysnatremia (normonatremia, hyponatremic and hypernatremic). Data were evaluated using univariate logistic regression. Mortality was determined through hazard ratios (HR) with 95% confidence intervals. Results: 185 patients were included. The prevalence of dysnatremia was 24.9%: 17 with hyponatremia (9.2%) and 29 with hypernatremia (15.7%). Patients with dysnatremia more frequently suffered from chronic kidney disease (23.8%), requiring renal replacement therapy (25.9%), and elevated levels of creatinine, ferritin, and serum urea nitrogen. The presence of hypernatremia on admission influences a higher risk of death compared to normonatremic (HR = 1.73: 95% CI [1.12 – 2.68]; p = 0.013). Conclusions: The presence of hypernatremia on admission influenced survival compared to normonatremia. Furthermore, dysnatremic patients more frequently suffered from chronic kidney disease, need for renal replacement therapy, and elevated levels of creatinine, ferritin, and urea nitrogen.
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COVID-19, Críticamente enfermos, Hiponatremia, Hipernatremia;, Mortalidad