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Sex differences in electrolyte imbalances caused by SARS-CoV-2: a case-control study
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  • Arianna Pani,
  • Elvira Inglese,
  • Massimo Puoti,
  • Valeria Cento,
  • Claudia Alteri,
  • Alessandra Romandini,
  • Federica Di Ruscio,
  • Michele Senatore,
  • Mauro Moreno,
  • Paolo Tarsia,
  • Fabrizio Colombo,
  • Oscar Epis,
  • Valentina Panetta,
  • Chiara Vismara,
  • Andrea Bellone,
  • Francesco Scaglione
Arianna Pani
Università degli Studi di Milano

Corresponding Author:[email protected]

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Elvira Inglese
Niguarda Hospital
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Massimo Puoti
Niguarda Hospital
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Valeria Cento
Università degli Studi di Milano
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Claudia Alteri
Università degli Studi di Milano
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Alessandra Romandini
Università degli Studi di Milano
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Federica Di Ruscio
Niguarda Hospital
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Michele Senatore
Università degli Studi di Milano
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Mauro Moreno
Niguarda Hospital
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Paolo Tarsia
Niguarda Hospital
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Fabrizio Colombo
Niguarda Hospital
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Oscar Epis
Niguarda Hospital
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Valentina Panetta
L’altrastatistica srl - Consultancy & Training
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Chiara Vismara
Niguarda Hospital
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Andrea Bellone
Niguarda Hospital
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Francesco Scaglione
Università degli Studi di Milano
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Abstract

Background - Since SARS-CoV-2 spread, evidences regarding sex differences in progression and prognosis of COVID-19 have emerged. Besides this, studies on patients’ clinical characteristics have described electrolyte imbalances as one of the recurrent features of COVID-19. Methods - We performed a case-control study on all patients admitted to the emergency department (ED) from 1st March to 31st May 2020 who had undergone a blood gas analysis and a nasopharyngeal swab test for SARS-CoV-2 by rtPCR. We defined positive patients as cases and negatives as controls. The study was approved by the local ethics committee Area 3 Milan. Data were automatically extracted from the hospital laboratory SQL-based repository in anonymized form. We considered as outcomes potassium (K+), sodium (Na+), chlorine (Cl-) and calcium (Ca++) as continuous and as categorical variables, in their relation with age, sex and SARS-CoV-2 infection status. Results - We observed a higher prevalence of hypokalemia among patients positive for SARS-CoV-2 (13.7% vs 6% of negative subjects). Positive patients had a higher probability to be admitted to the ED with hypokalemia (OR 2.75, 95% CI 1.8-4.1 p<0.0001) and women were twice as likely to be affected than men (OR 2.43, 95% CI 1.67-3.54 p<0.001). Odds ratios for positive patients to manifest with an alteration in serum Na+ was (OR 1.6, 95% CI 1.17-2.35 p<0.001) and serum chlorine (OR 1.6, 95% CI 1.03-2.69 p<0.001). Notably, OR for positive patients to be hypocalcemic was 7.2 (95% IC 4.8-10.6 p<0.0001) with a low probability for women to be hypocalcemic (OR 0.63, 95% IC 0.4-0.8 p=0.005). Conclusions - SARS-CoV-2 infection is associated with a higher prevalence of hypokalemia, hypocalcemia, hypochloremia and sodium alterations. Hypokalemia is more frequent among women and hypocalcemia among men.
24 Mar 2021Submitted to International Journal of Clinical Practice
25 Mar 2021Submission Checks Completed
25 Mar 2021Assigned to Editor
27 Mar 2021Reviewer(s) Assigned
21 Jun 2021Review(s) Completed, Editorial Evaluation Pending
23 Jun 2021Editorial Decision: Revise Minor
23 Jul 20211st Revision Received
24 Jul 2021Assigned to Editor
24 Jul 2021Submission Checks Completed
24 Jul 2021Review(s) Completed, Editorial Evaluation Pending
25 Jul 2021Reviewer(s) Assigned
31 Jul 2021Editorial Decision: Revise Major
02 Sep 20212nd Revision Received
08 Sep 2021Assigned to Editor
08 Sep 2021Submission Checks Completed
08 Sep 2021Review(s) Completed, Editorial Evaluation Pending
09 Sep 2021Reviewer(s) Assigned
14 Sep 2021Editorial Decision: Accept