Association of hypernatremia with outcomes of COVID-19 patients: A protocol for systematic review and meta-analysis

Background:This systematic review and meta-analysis aimed to assess the association of hypernatremia with the outcomes of COVID-19 patients. Methods:We performed a systematic literature search on PubMed, Google Scholar, and Science Direct until October 2021 and found a total of 131 papers. With meticulous screening finally, 17 papers met the inclusion criteria. COVID-19 patients with sodium levels greater than the reference level were the study population and the outcome of interest was the poor outcome; such as mortality, mechanical ventilation, intensive care unit (ICU) admission, and prolonged hospital stay. The pooled estimate was calculated as the odds ratio (OR). Results:There were 19,032 patients with hypernatremia in the 17 studies included. An overall random effect meta-analysis showed that hypernatremia was associated with mortality (OR: 3.18 [1.61, 6.28], P < .0001, I-2 = 91.99%), prolong hospitalization (OR: 1.97 [1.37, 2.83], P < .001, I-2 = 0.00%) and Ventilation (OR: 5.40 [1.89, 15.42], P < .001, I-2 = 77.35%), ICU admission (OR: 3.99 [0.89, 17.78], P = .07, I-2 = 86.79%). Meta-regression analysis showed the association of age with the ICU outcome of hypernatremia patients. Whereas, other parameters like male, hypertension, chronic kidney disease, and diabetes mellitus did not significantly influence the odds ratio. Conclusion:Hypernatremia was markedly associated with poor outcomes in patients with COVID-19. Hence, a blood ionogram is warranted and special attention must be given to hypernatremia COVID-19 patients.