Association of Hyponatremia on Mortality in Cryptococcal Meningitis: A Prospective Cohort.
Association of Hyponatremia on Mortality in Cryptococcal Meningitis: A Prospective Cohort.
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DOI：
10.1093/ofid/ofac301
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发表时间：
2022-07
影响因子：
4.2
通讯作者：
中科院分区：
文献类型：
--
作者：
钠异常常见于中枢神经系统感染，可能由脑性盐耗、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率产生不利影响尚不清楚。我们进行了二次分析的数据，从2个随机试验的人类免疫缺陷病毒感染的成年乌干达人与CM。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率相关。在816例CM受试者中，741例（91%）有基线钠测量结果：121例（16%）有3-4级低钠血症（<125 mmol/L），194例（26%）有2级低钠血症（125-129 mmol/L），426例（57%）基线钠为130-145 mmol/L。 低钠血症（<125 mmol/L）与较高的初始脑脊液（CSF）定量培养负荷（P <0.001）、较高的初始CSF开放压（P <0.01）、较低的基线格拉斯哥昏迷量表评分（P <0.01）和较高的基线癫痫发作百分比（P = 0.03）相关。 在未校正和校正的生存分析中，与钠130-145 mmol/L的患者相比，血清钠<125 mmol/L与2周死亡率增加相关（校正的风险比，1.87 [95%置信区间，1.26-2.79]; P <0.01）。 低钠血症在CM中很常见，并与过高的死亡率相关。一个标准化的管理方法，以正确诊断和纠正低钠血症的CM需要开发和测试。在HIV相关的隐球菌脑膜炎中，基线低钠血症很常见，并与隐球菌培养负荷增加、颅内压升高和精神状态改变有关。基线血清钠<125 mmol/L与诊断后30天内死亡率增加相关。
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 (P < .001), higher initial CSF opening pressure (P < .01), lower baseline Glasgow Coma Scale score (P < .01), and a higher percentage of baseline seizures (P = .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]; P < .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. In HIV-associated cryptococcal meningitis, baseline hyponatremia is common and is associated with higher cryptococcal culture burden, increased intracranial pressures, and altered mental status. Baseline serum sodium <125 mmol/L is associated with increased mortality through 30 days from diagnosis.
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影响因子：
2.5
作者：
Lawrence DS;Youssouf N;Molloy SF;Alanio A;Alufandika M;Boulware DR;Boyer-Chammard T;Chen T;Dromer F;Hlupeni A;Hope W;Hosseinipour MC;Kanyama C;Lortholary O;Loyse A;Meya DB;Mosepele M;Muzoora C;Mwandumba HC;Ndhlovu CE;Niessen L;Schutz C;Stott KE;Wang D;Lalloo DG;Meintjes G;Jaffar S;Harrison TS;Jarvis JN
通讯作者：
Jarvis JN
用于检测隐球菌脑膜炎的高病态风险患者的大脑血氧饱和度。
影响因子：
4.2
作者：
Diehl JW;Hullsiek KH;Okirwoth M;Stephens N;Abassi M;Rhein J;Meya DB;Boulware DR;Musubire AK;ASTRO-CM Trial Team
通讯作者：
ASTRO-CM Trial Team
影响因子：
4.4
作者：
Misra, Usha K.;Kalita, Jayantee;Singh, Rajesh K.
通讯作者：
Singh, Rajesh K.
影响因子：
56.3
作者：
Rhein, Joshua;Hullsiek, Kathy Huppler;Nielsen, Kirsten
通讯作者：
Nielsen, Kirsten
影响因子：
3.4
作者：
Zheng, Feixia;Ye, Xiuyun;Jiang, Longxiang
通讯作者：
Jiang, Longxiang