ECE2022 Poster Presentations Pituitary and Neuroendocrinology (127 abstracts)
Inverse relationship between il-6 and sodium levels in patients with COVID-19 and other respiratory tract infections
Sophie Monnerat 1 , Cihan Atila 1 , Roland Bingisser 2 , Martin Siegemund 3 , Maurin Lampart 4,4 , Marco Rüegg 2 , Núria Zellweger 3 , Stefan Osswald 4 , Katharina Rentsch 5 , Mirjam Christ-Crain 1 & Raphael Twerenbold 4,6
1Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; 2Emergency Department, University Hospital Basel, Basel, Switzerland; 3Department of Intensive Care, University Hospital Basel, Basel, Switzerland; 4Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland; 5Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland; 6University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
Background: Hyponatremia is highly prevalent in patients with COVID-19. One of the most common causes of hyponatremia in these patients is the syndrome of inadequate antidiuresis (SIAD). Interleukin 6 (IL-6) is a key mediator of inflammation in COVID-19. We hypothesized that hyponatremia in COVID-19 is due to IL-6 mediated non-osmotic arginine vasopressin (AVP) secretion, and that the inverse association between IL-6 and plasma sodium concentration is stronger in COVID-19 compared to other respiratory infections.
Methods: This is a secondary analysis of a prospective, observational, cohort study including patients with COVID-19 suspicion admitted to the Emergency Department, University Hospital of Basel, Switzerland, between March and July 2020. We included patients with PCR-confirmed COVID-19 and patients without COVID-19 but similar symptoms, further subclassified in bacterial and other viral respiratory infections. The primary objective was to investigate the association between plasma sodium levels and IL-6 levels.
Results: 500 patients were included, of whom 184 (37%) with COVID-19, 92 (18%) with bacterial respiratory infections, 224 (45%) with other viral respiratory infections. Hyponatremia prevalence was higher in patients with COVID-19 compared to patients with other viral respiratory infections (28% vs 12%, P<0.01), and similar to patients with bacterial respiratory infections (28% vs 30%, P<0.41). In all three groups, median [IQR] IL-6 levels were significantly higher in hyponatremic compared to normonatremic patients (COVID-19: 43.4 [28.4, 59.8] vs 9.2 [2.8, 32.7] pg/ml, P<0.0001; bacterial: 122.1 [63.0, 282.0] vs 67.1 [24.9, 252.0] pg/ml, P<0.05; viral: 14.1 [6.9, 84.7] vs 4.3 [2.1, 14.4] pg/ml, P<0.05). IL-6 levels were negatively correlated with plasma sodium levels in COVID-19, whereas the correlation in bacterial and other viral infections was weaker (COVID-19: ρ=− 0.52, P< 0.001; bacterial: ρ=− 0.24, P=0.056, viral: ρ=− 0.24, P< 0.001).
Conclusion: IL-6 levels were inversely correlated with plasma sodium levels, with a stronger correlation in patients with COVID-19 compared to patients with bacterial and other viral infections. IL-6 might stimulate AVP secretion and lead to higher rates of hyponatremia due to the syndrome of inadequate antidiuresis in these patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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