Clinical Significance of Hyponatremia in Tuberculous Meningitis: A Prospective Cohort in Indonesia.

IF 3.8 4区医学 Q2 IMMUNOLOGY Open Forum Infectious Diseases Pub Date : 2024-11-15 eCollection Date: 2024-12-01 DOI:10.1093/ofid/ofae673

Sofiati Dian, Edwin Ardiansyah, Lidya Chaidir, Arjan van Laarhoven, Rovina Ruslami, Bachti Alisjahbana, Ahmad Rizal Ganiem, Reinout van Crevel

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Abstract

Background: Hyponatremia is common in tuberculous meningitis (TBM), but its impact on disease severity and outcomes is unclear.

Methods: In a cohort of 864 adult patients with TBM in Indonesia, we assessed the prevalence and prognostic significance of hyponatremia, classified as moderate (120-130 mEq/L) or severe (<120 mEq/L). Patients received standard antituberculous therapy and corticosteroids and were followed for 1-year mortality.

Results: Hyponatremia occured in 86.8% of patients, with 26% classified as severe. Severe hyponatremia associated with male, younger age, a lower Glasgow Coma Scale (GCS), and markers of more severe disease (P < .05). One-year mortality was 46.5% and associated with older age, HIV infection, lower GCS, markers of neurologic severity, fever, and thrombocytosis. Severe hyponatremia predicted mortality in univariate analysis showed no impact in HIV-positive patients.

Conclusions: Hyponatremia reflects disease severity in TBM but does not independently predict mortality, suggesting limited benefit from agressive correction.

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结核性脑膜炎低钠血症的临床意义：印度尼西亚的一项前瞻性队列研究。

背景：低钠血症在结核性脑膜炎（TBM）中很常见，但其对疾病严重程度和结局的影响尚不清楚。方法：在印度尼西亚的864名成年TBM患者队列中，我们评估了低钠血症的患病率和预后意义，分为中度（120-130 mEq/L）和重度（结果：86.8%的患者发生低钠血症，26%为重度）。严重低钠血症与男性、年轻、格拉斯哥昏迷评分（GCS）较低以及更严重疾病标志物相关（P < 0.05）。一年死亡率为46.5%，与年龄较大、HIV感染、GCS较低、神经系统严重程度标志物、发热和血小板增多有关。单变量分析显示严重低钠血症对hiv阳性患者的预测死亡率没有影响。结论：低钠血症反映TBM的疾病严重程度，但不能独立预测死亡率，表明积极纠正的益处有限。

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来源期刊

Open Forum Infectious Diseases Medicine-Neurology (clinical)

CiteScore

6.70

自引率

4.80%

发文量

630

审稿时长

9 weeks

期刊介绍： Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.