Tugume Lillian, Fieberg Ann, Ssebambulidde Kenneth, Nuwagira Edwin, Williams Darlisha A, Mpoza Edward, Rutakingirwa Morris K, Kagimu Enoch, Kasibante John, Nsangi Laura, Jjunju Samuel, Musubire Abdu K, Muzoora Conrad, Lawrence David S, Rhein Joshua, Meya David B, Hullsiek Kathy Huppler, Boulware David R, Abassi Mahsa
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA.
Open Forum Infect Dis. 2022 Jun 17;9(7):ofac301. doi: 10.1093/ofid/ofac301. eCollection 2022 Jul.
Sodium abnormalities are frequent in central nervous system infections and may be caused by cerebral salt wasting, syndrome of inappropriate antidiuretic hormone secretion, or medication adverse events. In cryptococcal meningitis (CM), the prevalence of baseline hyponatremia and whether hyponatremia adversely impacts survival is unknown.
We conducted a secondary analysis of data from 2 randomized trials of human immunodeficiency virus-infected adult Ugandans with CM. We grouped serum sodium into 3 categories: <125, 125-129, and 130-145 mmol/L. We assessed whether baseline sodium abnormalities were associated with clinical characteristics and survival.
Of 816 participants with CM, 741 (91%) had a baseline sodium measurement available: 121 (16%) had grade 3-4 hyponatremia (<125 mmol/L), 194 (26%) had grade 2 hyponatremia (125-129 mmol/L), and 426 (57%) had a baseline sodium of 130-145 mmol/L. Hyponatremia (<125 mmol/L) was associated with higher initial cerebrospinal fluid (CSF) quantitative culture burden ( < .001), higher initial CSF opening pressure ( < .01), lower baseline Glasgow Coma Scale score ( < .01), and a higher percentage of baseline seizures ( = .03). Serum sodium <125 mmol/L was associated with increased 2-week mortality in unadjusted and adjusted survival analyses (adjusted hazard ratio, 1.87 [95% confidence interval, 1.26-2.79]; < .01) compared to those with sodium 130-145 mmol/L.
Hyponatremia is common in CM and is associated with excess mortality. A standardized management approach to correctly diagnose and correct hyponatremia in CM needs to be developed and tested.
钠异常在中枢神经系统感染中很常见，可能由脑性盐耗综合征、抗利尿激素分泌不当综合征或药物不良事件引起。在隐球菌性脑膜炎（CM）中，基线低钠血症的患病率以及低钠血症是否对生存产生不利影响尚不清楚。
我们对两项针对感染人类免疫缺陷病毒的乌干达成年CM患者的随机试验数据进行了二次分析。我们将血清钠分为3类：<125、125 - 129和130 - 145 mmol/L。我们评估了基线钠异常是否与临床特征和生存相关。
在816例CM患者中，741例（91%）有可用的基线钠测量值：121例（16%）为3 - 4级低钠血症（<125 mmol/L），194例（26%）为2级低钠血症（125 - 129 mmol/L），426例（57%）的基线钠为130 - 145 mmol/L。低钠血症（<125 mmol/L）与更高的初始脑脊液（CSF）定量培养负荷（<0.001）、更高的初始CSF开放压（<0.01）、更低的基线格拉斯哥昏迷量表评分（<0.01）以及更高比例的基线癫痫发作（=0.03）相关。与钠水平为130 - 145 mmol/L的患者相比，血清钠<125 mmol/L在未调整和调整后的生存分析中均与2周死亡率增加相关（调整后的风险比，1.87[95%置信区间，1.26 - 2.79]；<0.01）。
低钠血症在CM中很常见，且与过高死亡率相关。需要制定并测试一种标准化的管理方法，以正确诊断和纠正CM中的低钠血症。
