Hyponatremia in Children With Bacterial Meningitis
Hyponatremia in Children With Bacterial Meningitis
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DOI：
10.3389/fneur.2019.00421
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发表时间：
2019-04-30
影响因子：
3.4
通讯作者：
Jiang, Longxiang
中科院分区：
文献类型：
--
作者：
Zheng, Feixia;Ye, Xiuyun;Jiang, Longxiang
背景资料：低钠血症经常被描述为细菌性脑膜炎的常见并发症，尽管其在细菌性脑膜炎儿童中的发生率和临床病程尚不清楚。本研究的目的是调查的频率，临床特点和预后与小儿低钠血症，由于细菌性脑膜炎。方法：我们进行了回顾性分析，提供标准的护理与细菌性脑膜炎的儿童。其中包括175名儿童。我们记录了所有参与者的症状和体征、实验室和微生物学数据、放射学检查结果以及住院期间发生的并发症。使用最大儿科脑功能分类（PCPC）和最小格拉斯哥昏迷量表（GCS）确定疾病严重程度。结果：低钠血症（< 135 mmol/L）116例（66.4%），其中轻度（130-135 mmol/L）77例，中度（125-129 mmol/L）26例，重度（< 125 mmol/L）13例。低钠血症与入院前症状持续时间较短、CSF白色细胞计数较高和住院时间较长相关。中度和重度低钠血症与惊厥增加、意识受损、CSF蛋白水平改变、最大PCPC评分较高和最小GCS评分较低相关。严重低钠血症还与全身并发症的发生相关，包括休克、多器官功能障碍综合征、需要机械通气的呼吸衰竭和不良结局的增加（PCPC >= 2）。低钠血症与神经系统并发症的发生无关。Logistic回归分析显示，惊厥（OR 12.09，95% CI 2.63-56.84）和血糖> 6.1mmol/L（OR 8.28，95% CI 1.65-41.60）是发生严重低钠血症的危险因素。中、重度低钠血症影响小儿细菌性脑膜炎的严重程度。只有严重的低钠血症影响儿童细菌性脑膜炎患者的短期预后。我们建议出现抽搐和血糖水平升高的小儿细菌性脑膜炎患者应检查是否有严重的低钠血症。需要进一步的研究来评估治疗低钠血症的有效性。
Background: Hyponatremia has frequently been described as a common complication associated with bacterial meningitis, though its frequency and clinical course in children with bacterial meningitis are unclear. The present study aimed to investigate the frequency, clinical characteristics, and prognosis associated with pediatric hyponatremia due to bacterial meningitis.Methods: We performed a retrospective review of children with bacterial meningitis provided with standard care. One hundred seventy-five children were included. We documented all participants' symptoms and signs, laboratory and microbiological data, radiological findings, and complications that occurred during their hospital admission. Disease severity was determined using the maximum Pediatric Cerebral Performance Category (PCPC) and minimum Glasgow Coma Scale (GCS). Residual deficits were assessed using PCPC at discharge.Results: Hyponatremia (< 135 mmol/L) was seen in 116 (66.4%) of the patients assessed and was classified as mild (130-135 mmol/L) in 77, moderate (125-129 mmol/L) in 26, and severe (< 125 mmol/L) in 13. Hyponatremia was associated with a shorter duration of symptoms before admission, higher CSF white cell counts, and a longer duration of hospitalization. Moderate and severe hyponatremia were associated with an increase in convulsions, impaired consciousness, altered CSF protein levels, higher maximum PCPC scores, and lower minimum GCS scores. Severe hyponatremia was further associated with the development of systemic complications including shock, multiple organ dysfunction syndrome, respiratory failure requiring mechanical ventilation, and an increase in poor outcome (PCPC >= 2). Hyponatremia was not associated with the development of neurologic complications. Logistic regression analyses revealed that convulsions (OR 12.09, 95% CI 2.63-56.84) and blood glucose levels > 6.1 mmol/L (OR 8.28, 95% CI 1.65-41.60) predicted severe hyponatremia.Conclusion: Hyponatremia occurred in 66.4% of the assessed pediatric bacterial meningitis patients. Moderate and severe hyponatremia affected the severity of pediatric bacterial meningitis. Only severe hyponatremia affected the short-term prognosis of patients with pediatric bacterial meningitis. We recommend that patients with pediatric bacterial meningitis who exhibit convulsions and increased blood glucose levels should be checked for severe hyponatremia. Further studies are needed to evaluate the effectiveness of treatment of hyponatremia.