Evidence map›Paper›PMID 33624101›Full record

ArticleThe Journal of clinical endocrinology and metabolism2021

Dysnatremia is a Predictor for Morbidity and Mortality in Hospitalized Patients with COVID-19.

Ploutarchos Tzoulis, Julian A Waung, Emmanouil Bagkeris, Ziad Hussein, Aiyappa Biddanda, John Cousins, Alice Dewsnip, Kanoyin Falayi, Will McCaughran, Chloe Mullins and 9 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of clinical endocrinology and metabolism, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
61citing papers in PubMed, 4 pooled it
14.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

61 citing papers in PubMed, 4 syntheses or guidelines pooled it, 114 citations in OpenAlex.

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  12. Effect of Pituitary-Target Gland Axis on RAAS in the Context of COVID-19.International journal of medical sciences · 2025
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1 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors at 4 institutions in 1 country.

Ploutarchos TzoulisDepartment of Metabolism & Experimental Therapeutics, Division of Medicine, University College London, London, UK.ORCID 0000-0003-4228-071X
Julian A WaungDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
Emmanouil BagkerisNational Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
Ziad HusseinDepartment of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK.
Aiyappa BiddandaDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
John CousinsDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
Alice DewsnipDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
Kanoyin FalayiDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
Will McCaughranDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
Chloe MullinsDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
Ammara NaeemDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
Muna NwokoloDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
Helen QuahDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
Syed BitatDepartment of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK.
Eithar DeyabDepartment of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK.
Swarupini PonnampalamDepartment of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK.
Pierre-Marc BoulouxCentre for Neuroendocrinology, Royal Free Campus, University College London, London, UK.
Hugh MontgomeryDepartment of Endocrinology & Diabetes, Whittington Health NHS Trust, London, UK.
Stephanie E BaldewegDepartment of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, UK.
Whittington Health NHS Trust · GBUniversity College London Hospitals NHS Foundation Trust · GBImperial College London · GBThe Royal Free Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

contextDysnatremia is an independent predictor of mortality in patients with bacterial pneumonia. There is paucity of data about the incidence and prognostic impact of abnormal sodium concentration in patients with coronavirus disease 2019 (COVID-19).

objectiveThis work aimed to examine the association of serum sodium during hospitalization with key clinical outcomes, including mortality, need for advanced respiratory support and acute kidney injury (AKI), and to explore the role of serum sodium as a marker of inflammatory response in COVID-19.

methodsThis retrospective longitudinal cohort study, including all adult patients who presented with COVID-19 to 2 hospitals in London over an 8-week period, evaluated the association of dysnatremia (serum sodium < 135 or > 145 mmol/L, hyponatremia, and hypernatremia, respectively) at several time points with inpatient mortality, need for advanced ventilatory support, and AKI.

resultsThe study included 488 patients (median age, 68 years). At presentation, 24.6% of patients were hyponatremic, mainly due to hypovolemia, and 5.3% hypernatremic. Hypernatremia 2 days after admission and exposure to hypernatremia at any time point during hospitalization were associated with a 2.34-fold (95% CI, 1.08-5.05; P = .0014) and 3.05-fold (95% CI, 1.69-5.49; P < .0001) increased risk of death, respectively, compared to normonatremia. Hyponatremia at admission was linked with a 2.18-fold increase in the likelihood of needing ventilatory support (95% CI, 1.34-3.45, P = .0011). Hyponatremia was not a risk factor for in-hospital mortality, except for the subgroup of patients with hypovolemic hyponatremia. Sodium values were not associated with the risk for AKI and length of hospital stay.

conclusionAbnormal sodium levels during hospitalization are risk factors for poor prognosis, with hypernatremia and hyponatremia being associated with a greater risk of death and respiratory failure, respectively. Serum sodium values could be used for risk stratification in patients with COVID-19.

Indexed as

Acute Lung InjuryAgedAged, 80 and overCohort StudiesCOVID-19FemaleHospital MortalityHumansHypernatremiaHyponatremiaIncidenceLength of StayLondonLongitudinal StudiesMaleMiddle AgedSodiumCOVID-19hypernatremiahyponatremiaSARS-CoV-2SIADsodium

Identifiers

PMID33624101
PMCPMC7928894
OpenAlexW3132622276

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.