Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis

Admission plasma potassium and length of hospital stay: a meta-analysis

OBJECTIVE

Hypokalaemia and hyperkalaemia ('dyskalaemia') are commonly seen in patients requiring emergency hospital admission. The adverse effect of dyskalaemia on mortality is well described but there are few data for the effect on hospital length of stay. We sought to determine the association of serum potassium concentration with in-hospital length of stay.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A structured search of MEDLINE, PubMed and SCOPUS databases to 19 March 2021.

ELIGIBILITY CRITERIA

Observational cohort studies defining exposure of interest as serum potassium levels (at admission or within the first 72 hours) and with outcome of interest as length of hospital stay. Studies had to provide estimates of length of stay as a comparison between normokalaemia and defined ranges of hyperkalaemia or hypokalaemia.

DATA EXTRACTION AND SYNTHESIS

We identified 39 articles published to March 2021 that met the inclusion and exclusion criteria. Study selection, data extraction and quality assessment were carried out by two reviewers working independently and in duplicate, to assessed eligibility and risk of bias, and extract data from eligible studies. Random effects models were used to pool estimates across the included studies. Meta-analyses were performed using Cochrane-RevMan.

RESULTS

Five studies were included in the meta-analysis. Compared with the reference group (3.5-5.0 mmol/L), the pooled raw differences of medians were 4.45 (95% CI 2.71 to 6.91), 1.99 (95% CI 0.03 to 3.94), 0.98 (95% CI 0.91 to 1.05), 1.51 (95% CI 1.03 to 2.0), 1 (95% CI 0.75 to 1.25) and 2.76 (95% CI 1.24 to 4.29) for patients with potassium levels of <2.5, 2.5 to <3.0, 3.0 to <3.5, <5 to 5.5, <5.5 to 6 and >6.0 mmol/L, respectively.

CONCLUSION

Hospital length of stay follows a U-shaped distribution, with duration of admission being twofold greater at the extremes of the potassium range.

Stability and structure-activity relationship of the SPA4 peptide under ambient and stressed conditions of lung injury

Lung inflammation and injuries are major health problems. The SPA4 peptide (amino acid sequence GDFRYSDGTPVNYTNWYRGE) binds to Toll-like receptor-4 and exerts anti-inflammatory activity. In this study, we have determined the stability of the structure and structure-activity relationship of the SPA4 peptide under ambient and stressed conditions of lung injury. The SPA4 peptide was maintained at different pH and temperatures, in solutions of different ionic strengths, and simulated lung fluids. The primary and secondary structure of the SPA4 peptide was determined by ultraviolet-visible (UV-VIS) and circular dichroism (CD) spectroscopy. The activity of the SPA4 peptide was determined by measurement of secreted levels of chemokine C-X-C motif ligand 1/keratinocyte-derived chemokine (CXCL1/KC) and lactate by primary mouse lung epithelial cells against lipopolysaccharide (LPS) stimuli. Our results demonstrate the stability of the structure of the SPA4 peptide at room temperature and 4 °C over 10 days. The original UV-VIS spectra of the SPA4 peptide followed a typical pattern when incubated in solutions of pH 5.7, 7.0, and 8.0 at different temperatures, simulated lung fluids, and most of the chemical components. Slight shifts in the absorbance peaks, derivative values, and vibrational fine structures were noted in the fourth-derivative spectra of the SPA4 peptide under some conditions. An increased level of lactate is the hallmark of lung injury. The SPA4 peptide on its own and in the presence of lactate exerts anti-inflammatory activity. The primary and secondary structure and the activity of the SPA4 peptide remain intact when pre-incubated in 2 mM sodium lactate solution. The results provide important insights about the stability and structure-activity relationship of the SPA4 peptide.

Dietary macrominerals: Updated review of their role and orchestration in human nutrition throughout the life cycle with sex differences

Macrominerals play vital roles in a multitude of physiologic systems. A myriad of biochemical reactions are dependent on or affected by these electrolytes. The current review attempts to identify the role of macrominerals as calcium, phosphorus, magnesium, sodium, potassium and sulfur in human health, in addition to their absorption and homeostasis inside the body. We also focused on their amount in major food sources and the recommended daily intake of each macromineral. In addition, a deep insight into the orchestration of the 6 different macrominerals' requirements is presented across the human life cycle, beginning from fertility and pregnancy, and reaching adulthood and senility, with insight on interactions among them and underlying action mechanisms. The effect of sex is also presented for each mineral at each life stage to highlight the different daily requirements and/ or effects. The current review identified the role of macrominerals in human health, in addition to their absorption and homeostasis in the body. Based on the in-depth understanding of the factors influencing the metabolism of macrominerals, we could better explore their safety and possible therapeutic potential in specific disorders. There is still a need to precisely demonstrate the bioavailability of macrominerals from various types of functional food.

Risk factors for hyponatremia in acute exacerbation chronic obstructive pulmonary disease (AECOPD): a multicenter cross-sectional study

BACKGROUND

Hyponatremia is an independent predictor of poor prognosis, including increased mortality and readmission, in COPD patients. Identifying modifiable etiologies of hyponatremia may help reduce adverse events in patients with AECOPD. Therefore, the aim of this study was to explore the risk factors and underlying etiologies of hyponatremia in AECOPD patients.

METHODS

A total of 586 AECOPD patients were enrolled in this multicenter cross-sectional study. Finally, 323 had normonatremia, and 90 had hyponatremia. Demographics, underlying diseases, comorbidities, symptoms, and laboratory data were collected. The least absolute shrinkage and selection operator (LASSO) regression was used to select potential risk factors, which were substituted into binary logistic regression to identify independent risk factors. Nomogram was built to visualize and validate binary logistics regression model.

RESULTS

Nine potential hyponatremia-associated variables were selected by LASSO regression. Subsequently, a binary logistic regression model identified that smoking status, rate of community-acquired pneumonia (CAP), anion gap (AG), erythrocyte sedimentation rate (ESR), and serum magnesium (Mg²⁺) were independent variables of hyponatremia in AECOPD patients. The AUC of ROC curve of nomogram was 0.756. The DCA curve revealed that the nomogram could yielded more clinical benefits if the threshold was between 10% and 52%.

CONCLUSIONS

Collectively, our results showed that smoking status, CAP, AG, ESR, and serum Mg²⁺ were independently associated with hyponatremia in AECOPD patients. Then, these findings indicate that pneumonia, metabolic acidosis, and hypomagnesemia were the underlying etiologies of hyponatremia in AECOPD patients. However, their internal connections need further exploration.

Age- and sex-related differences in community-acquired pneumonia at presentation to the emergency department: a retrospective cohort study

BACKGROUND AND IMPORTANCE

Because of its associated high morbidity and mortality, early identification and treatment of community-acquired pneumonia (CAP) are essential.

OBJECTIVES

To investigate age- and sex-related differences in clinical symptoms, radiologic findings and outcomes in patients presenting to the emergency department (ED) with CAP.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

Patients admitted to one Swiss ED with radiologically confirmed CAP between 1 January 2017 and 31 December 2018.

OUTCOME MEASURES AND ANALYSIS

Primary aim was to evaluate differences in clinical and radiologic presentation of men vs. women and patients >65 years vs. <65 years with CAP. Secondary outcomes were age- and sex-related differences in terms of Pneumonia Severity Index (PSI) risk class, need for ICU referral, mechanical ventilation, in-hospital mortality, 30-day readmission and 180-day pneumonia recurrence.

MAIN RESULTS

In total 467 patients with CAP were included. 211 were women (45%). 317 were ≥65 years (68%), of which 145 were women (46%). Older patients less commonly reported chest pain (13 vs. 27%; effect size 14%; 95% CI, 0.07-0.23), fever (39 vs. 53%, effect size 14%; 95% CI, 0.05-0.24), chills (6 vs. 20%; effect size 14%; 95% CI, 0.08-0.0.214), cough (44 vs. 57%; effect size 13%; 95% CI, 0.03-0.22), headache (5 vs. 15%, effect size 10%, 95% CI, 0.04-0.17) and myalgias (5 vs. 19%; effect size 14%; 95% CI, 0.07-0.21). However, 85% of patients with no symptoms were ≥65 years. PSI was lower in women [95 (SD 31) vs. 104 (SD 31); 95% CI, -14.44 to 2.35] and sputum was more common in men (32 vs. 22%; effect size 10%; 95% CI, -0.18 to -0.02). Raw mortality was higher in elderly patients [14 vs. 3%; odds ratio (OR), 4.67; 95% CI, 1.81-12.05], whereas it was similar in men and women (11 vs. 10%; OR, 1.22; 95% CI, 0.67-2.23).

CONCLUSION

Patients, less than 65 years with CAP presenting to the ED had significantly more typical symptoms such as chest pain, fever, chills, cough, headache and myalgias than those being above 65 years. No relevant differences between men and women were found in clinical presentation, except for PSI on admission, and radiologic findings and neither age nor sex was a predictor for mortality in CAP.

Haematological and biochemical pathology markers for a predictive model for ITU admission and death from COVID‐19: A retrospective study

Coronavirus disease (COVID‐19) caused by SARS‐CoV‐2 has affected over 227 countries. Changes in haematological and biochemical characteristics in patients with COVID‐19 are emerging as important features of the disease. This study aims to identify the pathological findings of COVID‐19 patients at Bedford Hospital by analysing laboratory parameters that were identified as significant potential markers of COVID‐19. Patients who were admitted to Bedford Hospital from March–July 2020 and had a positive swab for COVID were selected for this study. Clinical and laboratory data were collected using ICE system. Multiple haematological and biochemistry biomarkers were analysed using univariate and multivariate logistic regression to predict intensive therapy unit (ITU) admission and/or survival based on admission tests. Neutrophil‐to‐lymphocyte ratio (NLR) and C‐reactive protein were elevated in most patients, irrespective of ITU status, representing a common outcome of COVID‐19. This was driven by lymphopenia in 80% and neutrophilia in 42% of all patients. Multivariate logistic regression identified an increase in mortality associated with greater age, elevated NLR, alkaline phosphatase activity and hyperkalaemia. With the area under the receiver operating characteristic (ROC) curve of 0.706 +/− 0.04117, negative predictive value (NPV) 66.7% and positive predictive value (PPV) 64.9%. Analysis also revealed an association between increases in serum albumin and potassium concentrations and decreases in serum calcium, sodium and in prothrombin time, with admission to ITU. The area under the ROC curve of 0.8162 +/− 0.0403, NPV 63.3% and PPV 80.5%. These data suggest that using admission (within 4 days) measurements for haematological and biochemical markers, that we are able to predict outcome, whether that is survival or ITU admission.

Predictors and outcome of hyponatremia in patients with COVID 19: a single-center experience

Introduction/Aim: Hyponatremia (serum sodium 0.001) were the independent predictors of hyponatremia at the time of admission. The median length of hospital stay (LOS) was longer in patients with hyponatremia than patients with normonatremia (10 days vs. 8 days, p < 0.001). In multivariate analysis, hyponatremia was significantly associated with ICU admission or the need for mechanical ventilation (adjusted OR, 1.72; 95% confidence interval [95% CI], 1.03 to 2.85; p = 0.036). The severity of pneumonia, hemoglobin and lactate dehydrogenase levels, neutrophil-to-lymphocyte ratio (NLR), and body temperature were also associated with ICU admission or the need for mechanical ventilation. The oxygen saturation, male sex, serum albumin, NLR, and the ICU admission but not the hyponatremia on admission were significantly related to mortality. Conclusion: Hyponatremia on admission, even when mild, predicts a worse outcome in COVID-19 patients, and it should be considered in risk stratification.

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

The Emergency Heart Failure Mortality Risk Grade (EHMRG) can predict short-term mortality in patients admitted for acute heart failure (AHF) in the emergency department (ED). This paper aimed to evaluate if TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can improve in-hospital death prediction in patients at moderate-to-high risk, according to EHMRG score classification. From 1 January 2018 to 30 December 2019, we retrospectively enrolled all the consecutive subjects admitted to our Internal Medicine Department for AHF from the ED. We performed bedside echocardiography within the first 24 h of admission. We evaluated EHMRG and NYHA in the ED, days of admission in Internal Medicine, and in-hospital mortality. We assessed cutoffs with ROC curve analysis and survival with Kaplan–Meier and Cox regression. We obtained a cohort of 439 subjects; 10.3% underwent in-hospital death. Patients with normal TAPSE/PASp in EHMRG Classes 4, 5a, and 5b had higher survival rates (100%, 100%, and 94.3%, respectively), while subjects with pathologic TAPSE/PASp had lower survival rates (81.8%, 78.3%, and 43.4%, respectively) (p < 0.0001, log-rank test). TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can further stratify the risk of in-hospital death evaluated by EHMRG.

The syndrome of inappropriate antidiuresis after vaccination against COVID-19: case report

BACKGROUND

The Syndrome of Inappropriate Antidiuresis (SIADH) has been described to be associated with a multitude of conditions and medications, including the severe acute respiratory syndrome coronavirus 2. We describe the case of a patient with newly diagnosed and symptomatic SIADH after receiving the second COVID-19 vaccination not explained otherwise.

CASE PRESENTATION

A 79-year-old male person was admitted to the emergency department due to a worsening of his general health state expressed by weakness, fatigue and anorexia. Vital signs and clinical findings were normal, in particular the patient was considered to be euvolemic. Laboratory investigations revealed a serum sodium of 117 mmol/L, a serum osmolality of 241 mosm/kg and a urea of 1.2 mmol/L with creatinine within normal range. Urine chemistry showed a urine osmolality of 412 mosm/kg and urine sodium of 110 mmol/L. TSH, C-reactive protein, and basal cortisol levels were normal. Under therapy with balanced crystalloid fluids, hyponatremia worsened and in absence of diuretic medications, diagnosis of SIADH was made. Since fluid restriction was not sufficiently effective, oral urea was administered. Under this therapy regimen hyponatremia resolved.

CONCLUSIONS

Local as well as systemic reactions have been described for the new mRNA-based vaccines including pain and fever. Therefore, it is imaginable that the vaccine might trigger SIADH in some patients.

Laboratory indicators in COVID-19 and other pneumonias: Analysis for differential diagnosis and comparison of dynamic changes during 400-day follow-up

Background

COVID-19 is spreading rapidly all over the world, the patients' symptoms can be easily confused with other pneumonia types. Therefore, it is valuable to seek a laboratory differential diagnostic protocol of COVID-19 and other pneumonia types on admission, and to compare the dynamic changes in laboratory indicators during follow-up.

Methods

A total of 143 COVID-19, 143 bacterial pneumonia and 145 conventional viral pneumonia patients were included. The model group consisted of 140 COVID-19, 80 bacterial pneumonia and 60 conventional viral pneumonia patients, who were age and sex matched. We established a differential diagnostic model based on the laboratory results of the model group on admission via a nomogram, which was validated in an external validation group. We also compared the 400-day dynamic changes of the laboratory indicators among groups.

Results

LASSO regression and multivariate logistic regression showed that eosinophils (Eos), total protein (TP), prealbumin (PA), potassium (K), high-density lipoprotein cholesterol (HDLC), and low-density lipoprotein cholesterol (LDLC) could differentiate COVID-19 from other pneumonia types. The C-index of the nomogram model was 0.922. Applying the nomogram to the external validation group showed an area under the curve (AUC) of 0.902. The 400-day change trends of the laboratory indexes varied among subgroups divided by sex, age, oxygenation index (OI), and pathogen.

Conclusion

The laboratory model was highly accurate at providing a new method to identify COVID-19 in pneumonia patients. The 400-day dynamic changes in laboratory indicators revealed that the recovery time of COVID-19 patients was not longer than that of other pneumonia types.

Independent predictors for 90-day readmission of emergency department patients admitted with sepsis: a prospective cohort study

Background

The primary objective of our study was to examine predictors for readmission in a prospective cohort of sepsis patients admitted to an emergency department (ED) and identified by the new Sepsis-3 criteria.

Method

A single-center observational population-based cohort study among all adult (≥18 years) patients with sepsis admitted to the emergency department of Slagelse Hospital during 1.10.2017–31.03.2018. Sepsis was defined as an increase in the sequential organ failure assessment (SOFA) score of ≥2. The primary outcome was 90-day readmission. We followed patients from the date of discharge from the index admission until the end of the follow-up period or until the time of readmission to hospital, emigration or death, whichever came first. We used competing-risks regression to estimate adjusted subhazard ratios (aSHRs) with 95% confidence intervals (CI) for covariates in the regression models.

Results

A total of 2110 patients were admitted with infections, whereas 714 (33.8%) suffered sepsis. A total of 52 patients had died during admission and were excluded leaving 662 patients (44.1% female) with a median age of 74.8 (interquartile range: 66.0–84.2) years for further analysis. A total of 237 (35,8%; 95% CI 32.1–39.6) patients were readmitted within 90 days, and 54(8.2%) had died after discharge without being readmitted. We found that a history of malignant disease (aSHR 1,61; 1.16–2.23), if previously admitted with sepsis within 1 year before the index admission (aSHR; 1.41; 1.08–1.84), and treatment with diuretics (aSHR 1.51; 1.17–1.94) were independent predictors for readmission. aSHR (1.49, 1.13–1.96) for diuretic treatment was almost unchanged after exclusion of patients with heart failure, while aSHR (1.47, 0.96–2.25) for malignant disease was slightly attenuated after exclusion of patients with metastatic tumors.

Conclusions

More than one third of patients admitted with sepsis, and discharged alive, were readmitted within 90 days. A history of malignant disease, if previously admitted with sepsis, and diuretic treatment were independent predictors for 90-day readmission.