Abstract
Background: COVID-19 has taken on pandemic proportions with growing interest in prognostic factors. Overhydration is a risk factor for mortality in several medical conditions with its role in COVID-19, assessed with bioelectrical impedance (BI), gaining research interest. COVID-19 affects hydration status. The aim was to determine the hydration predictive role on 90 d survival COVID-19 and to compare BI assessments with traditional measures of hydration.
Methods: We studied 127 consecutive COVID-19 patients. Hydration status was estimated using a 50 kHz phase-sensitive BI and estimated, compared with clinical scores and laboratory markers to predict mortality.
Results: Non-surviving COVID-19 patients had significantly higher hydration 85.2% (76.9-89.3) vs. 73.7% (73.2-82.1) and extracellular water/total body water (ECW/TBW) 0.67 (0.59-0.75) vs. 0.54 (0.48-0.61) ( p = 0.001, respectively), compared to surviving. Patients in the highest hydration tertile had increased mortality ( p = 0.012), Intensive Care Unit (ICU) admission ( p = 0.027), COVID-19 SEIMC score ( p = 0.003), and inflammation biomarkers [CRP/prealbumin ( p = 0.011)]. Multivariate analysis revealed that hydration status was associated with increased mortality. HR was 2.967 (95%CI, 1.459-6.032, p < 0.001) for hydration and 2.528 (95%CI, 1.664-3.843, p < 0.001) for ECW/TBW, which were significantly greater than traditional measures: CRP/prealbumin 3.057(95%CI, 0.906-10.308, p = 0.072) or BUN /creatinine 1.861 (95%CI, 1.375-2.520, p < 0.001). Hydration > 76.15% or ECW/TBW > 0.58 were the cut-off values predicting COVID-19 mortality with 81.3% and 93.8% sensitivity and 64 and 67.6% specificity, respectively. Hydration status offers a sensitive and specific prognostic test at admission, compared to established poor prognosis parameters.
Conclusions and relevance: Overhydration, indicated as high hydration (>76.15%) and ECW/TBW (>0.58), were significant predictors of COVID-19 mortality. These findings suggest that hydration evaluation with 50 kHz phase-sensitive BI measurements should be routinely included in the clinical assessment of COVID-19 patients at hospital admission, to identify increased mortality risk patients and assist medical care.
Keywords: COVID-19; extracellular water; hydration fat-free mass; hydration status; survival and mortality analysis; total body water.
【저자키워드】 COVID-19, extracellular water, hydration fat-free mass, hydration status, survival and mortality analysis, total body water., 【초록키워드】 Inflammation, pandemic, Biomarker, Mortality, intensive care unit, risk, risk factor, ICU, Laboratory, sensitivity, specificity, survival, Research, Patient, Prognostic factors, Medical care, Hospital admission, predictor, Hydration, prognostic, assessment, Admission, Care, parameters, predict, COVID-19 patients, Multivariate analysis, extracellular water, hydration status, marker, creatinine, COVID-19 mortality, COVID-19 patient, Predictive, water, total body water, clinical assessment, 95%CI, poor prognosis, measure, prealbumin, increased mortality, cut-off value, offer, Affect, Extracellular, Overhydration, body water, greater, highest, identify, significantly, proportion, indicated, determine, significantly higher, assist, medical condition, total body, 【제목키워드】 SARS-CoV2, vector, clinical, impedance, New,