Adding Hyponatremia to the “Rule-of-6” Prediction Tool Improves Performance in Identifying Hospitalised Patients with COVID-19 at Risk of Adverse Clinical Outcomes
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | Hyponatraemia (n = 161) | No Hyponatraemia (n = 1620) | p-Value |
---|---|---|---|
Baseline characteristics | |||
Age (years) | 51.9 (±16.9) | 41.2 (±14.0) | <0.001 |
Admitted in 2021 (compared with admission in 2020) | 58 (36.0%) | 363 (22.4%) | <0.001 |
Cycle threshold value of initial nasopharyngeal swab polymerase chain reaction for SARS-CoV-2 | 20.5 (±6.6) | 22.0 (±14.4) | 0.479 |
Absolute lymphocyte count (×109/L) | 1.5 (±0.9) | 1.9 (±1.4) | <0.001 |
C-reactive protein (mg/L) | 43.6 (±62.1) | 11.9 (±22.0) | <0.001 |
Ferritin (mcg/L) | 456.4 (±513.7) | 183.9 (±249.7) | <0.001 |
Lactate dehydrogenase (U/L) | 513.3 (±242.0) | 410.5 (±262.4) | <0.001 |
Serum sodium (mmol/L) | 131.9 (±2.6) | 138.5 (±1.9) | <0.001 |
Serum potassium (mmol/L) | 3.8 (±0.4) | 4.0 (±3.6) | 0.443 |
Serum urea (mmol/L) | 4.9 (±3.5) | 3.9 (±3.0) | <0.001 |
Serum creatinine (mmol/L) | 83.3 (±49.6) | 79.0 (±53.3) | 0.333 |
HbA1c (%) | 7.8 (±2.6) | 5.9 (±1.3) | <0.001 |
Sex (male) | 123 (77.4%) | 1303 (80.5%) | 0.338 |
Smoker | 17 (11.0%) | 113 (7.3%) | 0.104 |
Hypertension | 54 (33.5%) | 200 (12.3%) | <0.001 |
Hyperlipidaemia | 41 (25.5%) | 132 (8.1%) | <0.001 |
Diabetes mellitus | 45 (28.8%) | 85 (5.2%) | <0.001 |
Ischaemic heart disease | 13 (8.1%) | 38 (2.3%) | <0.001 |
No past medical history | 78 (48.4%) | 1321 (81.5%) | <0.001 |
Vaccinated against COVID-19 | 32 (19.9%) | 241 (14.9%) | 0.093 |
Asymptomatic | 14 (8.7%) | 293 (18.1%) | 0.003 |
Persistent fever beyond 72h | 48 (29.8%) | 156 (9.6%) | <0.001 |
Presence of pneumonia | 74 (46.0%) | 211 (13.0%) | <0.001 |
COVID-19 therapeutics | |||
Remdesivir | 33 (20.5%) | 53 (3.3%) | <0.001 |
Dexamethasone | 23 (14.3%) | 23 (2.1%) | <0.001 |
Baricitinib | 2 (1.2%) | 7 (0.4%) | 0.192 |
Tocilizumab | 0 (0.0%) | 3 (0.2%) | 0.999 |
Received COVID-19 therapeutics | 37 (23.0%) | 61 (3.8%) | <0.001 |
Clinical outcomes | |||
Length of hospital stay (days) | 2.2 (±2.5) | 1.0 (±2.0) | <0.001 |
Requiring supplemental oxygenation | 36 (22.4%) | 50 (3.1%) | <0.001 |
Acute kidney injury | 16 (9.9%) | 59 (3.6%) | <0.001 |
Required intensive care or experienced mortality | 27 (16.8%) | 33 (2.0%) | <0.001 |
Mortality | 4 (2.5%) | 9 (0.6%) | 0.024 |
Composite adverse outcome (requiring supplemental oxygenation, intensive care or mortality) | 41 (25.5%) | 67 (4.1%) | <0.001 |
Parameter | Adjusted Odds Ratio (95% Confidence Interval) | p-Value |
---|---|---|
Older age (per year) | 1.03 (1.01–1.05) | 0.003 |
No past medical history | 0.29 (0.16–0.54) | <0.001 |
Received COVID-19 vaccination | 0.81 (0.34–1.95) | 0.639 |
Hospital admission in 2021 (compared with 2020) | 1.42 (0.63–3.24) | 0.399 |
Elevated C-reactive protein (mg/L) | 1.01 (1.01–1.02) | <0.001 |
Elevated ferritin (mcg/L) | 1.00 (1.00–1.01) | 0.245 |
Elevated lactate dehydrogenase (U/L) | 1.00 (1.00–1.01) | 0.012 |
Hyponatremia (serum Na < 135 mmol/L) at presentation | 2.60 (1.45–4.67) | 0.001 |
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Sim, M.Y.; Ngiam, J.N.; Koh, M.C.Y.; Goh, W.; Chhabra, S.; Chew, N.W.S.; Chai, L.Y.A.; Tambyah, P.A.; Sia, C.-H. Adding Hyponatremia to the “Rule-of-6” Prediction Tool Improves Performance in Identifying Hospitalised Patients with COVID-19 at Risk of Adverse Clinical Outcomes. Pathogens 2024, 13, 694. https://doi.org/10.3390/pathogens13080694
Sim MY, Ngiam JN, Koh MCY, Goh W, Chhabra S, Chew NWS, Chai LYA, Tambyah PA, Sia C-H. Adding Hyponatremia to the “Rule-of-6” Prediction Tool Improves Performance in Identifying Hospitalised Patients with COVID-19 at Risk of Adverse Clinical Outcomes. Pathogens. 2024; 13(8):694. https://doi.org/10.3390/pathogens13080694
Chicago/Turabian StyleSim, Meng Ying, Jinghao Nicholas Ngiam, Matthew Chung Yi Koh, Wilson Goh, Srishti Chhabra, Nicholas W. S. Chew, Louis Yi Ann Chai, Paul Anantharajah Tambyah, and Ching-Hui Sia. 2024. "Adding Hyponatremia to the “Rule-of-6” Prediction Tool Improves Performance in Identifying Hospitalised Patients with COVID-19 at Risk of Adverse Clinical Outcomes" Pathogens 13, no. 8: 694. https://doi.org/10.3390/pathogens13080694