低钠血症在结核性脑膜炎中的临床意义：印度尼西亚的一项前瞻性队列研究

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

作者信息

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

机构信息

Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia.

Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.

出版信息

Open Forum Infect Dis. 2024 Nov 15;11(12):ofae673. doi: 10.1093/ofid/ofae673. eCollection 2024 Dec.

DOI:10.1093/ofid/ofae673

PMID:39660022

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11630896/

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 ( < .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.

摘要

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预后的影响尚不清楚。

方法

在印度尼西亚的864例成年TBM患者队列中，我们评估了低钠血症的患病率和预后意义，低钠血症分为中度（120 - 130 mEq/L）或重度（<120 mEq/L）。患者接受标准抗结核治疗和皮质类固醇治疗，并随访1年死亡率。

结果

86.8%的患者发生低钠血症，其中26%为重度。重度低钠血症与男性、较年轻、格拉斯哥昏迷量表（GCS）评分较低以及更严重疾病的标志物相关（P <.05）。1年死亡率为46.5%，与年龄较大、HIV感染、GCS评分较低、神经严重程度标志物、发热和血小板增多症相关。重度低钠血症在单因素分析中预测死亡率，但对HIV阳性患者无影响。