Hyponatremia and risk factors for death in human visceral leishmaniasis: new insights from a cross-sectional study in Brazil

Abstract

BackgroundVisceral leishmaniasis (VL) is an important and potentially fatal neglected tropical disease. The aim of this study was to investigate hyponatremia and risk factors for death among VL patients.MethodsThis is a cross-sectional study with VL patients admitted to a tertiary hospital in Northeast Brazil, from 2002 to 2009. Patients were divided into two groups: non-survivors and survivors. Hyponatremia was defined as serum sodium < 135 mEq/L. A logistic regression model was done to investigate risk factors for death.ResultsA total of 285 VL patients were included, with mean age 37 ± 15 years, and 74% were males. Thirty-four patients died (11.9%). Non-survivors had a significantly higher prevalence of dyspnea (38.2 vs. 16.7%, p = 0.003), pulmonary crackles (11.8 vs. 4.0%, p = 0.049), dehydration (23.5 vs. 10.8%, p = 0.033), oliguria (8.8 vs. 0.8%, p = 0.001) and jaundice (47.1 vs. 14.3%, p < 0.001). They also presented higher prevalence of hyponatremia (41.9 vs. 24.1%, p = 0.035), thrombocytopenia (91.2 vs. 65.3%, p = 0.002) and severe hypoalbuminemia (78.3 vs. 35.3%, p < 0.001). In multivariate analysis, moderate/severe hyponatremia (OR = 2.278, 95% CI = 1.046–4.962), thrombocytopenia (OR = 5.482, 95% CI = 1.629–18.443), jaundice (OR = 5.133, 95% CI = 1.793–14.696) and severe hypoalbuminemia (OR = 6.479, 95% CI = 2.124–19.766) were predictors of death.ConclusionHigher prevalence of dehydration, oliguria, pulmonary symptoms and liver involvement was found in non-survivors VL patients. Hypoalbuminemia and hyponatremia were frequent and significantly associated with mortality.

Disease Hazards and Immune Responses of Wistar Albino Rat Infected with Streptococcus Mutans

“…Electrolytes result of this study are in a match with [68] who indicated no significant (p>0.05) difference was observed in serum electrolytes of infected rats. Our results contraindicate with a study of [69] who found hyponatremia (decrease of Na+ level in the blood) has been observed in many infectious diseases caused by bacteria, viruses and parasites.…”

Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil

“…Finally, the diagnosis of secondary pneumonia during the first episode was a significant risk factor for relapse. Not surprisingly, edema, low platelet count and pneumonia were identified as predictors of mortality in previous study enrolling Brazilian VL patients (Druzian et al, 2015;Daher et al, 2017;Oliveira-Sena and Werneck, 2019). Our findings point to an interesting similarity among predictors for death and relapse.…”

Clinical and Laboratory Findings of Visceral Leishmaniasis in Children Hospitalized in Mashhad, Northeastern Iran: A Twenty-Year Retrospective Study

“…Decreasing Na serum level has been described as the reliable diagnostic laboratory item in VL patients in comparison with K, Ca, Cl and Mg electrolytes ( 13 ). Hyponatremia is presented as one of the mortality risk factors in human VL ( 14 ). Hyponatremia in 94.6% and hypokalemia in 26% of VL patients were reported.…”