Objective:

To investigate the effect of maximum serum electrolyte levels and their rate of change as a predictive factor for encephalopathy, seizure and stroke in patients hospitalized with SARS-CoV-2 infection. 

Background:

Among patients hospitalized with SARS-CoV-2, serum electrolyte levels and select markers have been shown to predict morbidity and mortality. However, an association between peak electrolyte values and their rate of change with the prevalence of severe neurological complications has not been completely characterized.

Design/Methods:

A retrospective analysis on 907 patients hospitalized with SARS-CoV-2 between April 2020 and March 2021 was conducted. Rate of change and peak values were evaluated for sodium, potassium, phosphorus, blood urea nitrogen, and creatinine in each patient. Correlations between electrolyte values and the presence of encephalopathy, seizure, or stroke were then determined and assessed for significance. 

Results:

Serum electrolyte values above the normal range were associated with a significant increase in the prevalence of encephalopathy for all electrolytes evaluated (p<0.0001). The rate of change of potassium was significantly different in patients with encephalopathy compared to those without (p<0.01). Patients with a peak serum phosphorus level greater than 4.5 mg/dL had a significantly higher number of seizures when compared to those with phosphorus levels within the normal reference range (5.4% vs 1.9%, p<0.05). Patients with a peak serum BUN ≥30 mg/dL or peak serum creatinine ≥1.1 mg/dL had a significantly higher prevalence of stroke compared to patients with a BUN or creatinine within the normal reference range (4.2% vs 0.72%, p<0.01, 2.9% vs 0.83%, p<0.05 respectively).

Conclusions:

These results suggest that the kinetics of select serum electrolytes correlate with a significant increase in the prevalence of encephalopathy, seizure and stroke in patients hospitalized with SARS-CoV-2 infection. Further studies that control for confounding variables are needed to validate serum kinetics as a predictive tool for neurological complications in these patients.