The Incidence and Risk Factors of Hyponatremia in Pulmonary Tuberculosis

Tomohiko Yoshida; Hidenori Masuyama; Hiroki Yamagata; Makoto Miyabayashi; Shunichiro Onishi; Yosuke Inaba; Minoru Takemoto

doi:10.1210/jendso/bvac130

The Incidence and Risk Factors of Hyponatremia in Pulmonary Tuberculosis

J Endocr Soc. 2022 Aug 25;6(11):bvac130. doi: 10.1210/jendso/bvac130. eCollection 2022 Oct 11.

Authors

Tomohiko Yoshida¹, Hidenori Masuyama², Hiroki Yamagata¹, Makoto Miyabayashi¹, Shunichiro Onishi¹, Yosuke Inaba³, Minoru Takemoto¹

Affiliations

¹ Department of Diabetes, Metabolism, and Endocrinology, School of Medicine, International University of Health and Welfare, Chiba, Japan.
² Department of Respiratory Medicine, International University of Health and Welfare, Ichikawa Hospital, Chiba, Japan.
³ Biostatistics Section, Chiba University Hospital Clinical Research Center, Chiba, Japan.

Abstract

Context: The syndrome of inappropriate antidiuresis (SIAD) with euvolemic hyponatremia may occur in patients with pulmonary tuberculosis (PTB), but little is known about the clinical characteristics of SIAD-associated hyponatremia in PTB patients.

Objective: This study aimed to investigate the frequency and risk factors of hyponatremia in PTB patients.

Methods: In this retrospective chart review, we examined the incidence and severity of hyponatremia in PTB patients. Multivariate analysis was conducted to identify risk factors for hyponatremia in PTB patients.

Results: Of the 161 patients who were screened, after excluding patients with hyperglycemia and renal failure, we enrolled and analyzed data from 113 participants. Hyponatremia occurred in 40.7% patients (<135 mEq/L). Univariate analysis revealed that the presence of hyponatremia was associated with old age, female sex, low body mass index, high glycosylated hemoglobin, C-reactive protein (CRP), and N-terminal pro-brain natriuretic peptide. Multivariable analysis indicated that hyponatremia was strongly associated with old age (odds ratio, 1.06; 95% CI, 1.03-1.09 for every 1-year age increase) and CRP values (odds ratio, 1.15; 95% CI, 1.03-1.30 for every 1-mg/dL increase in CRP). For 86 patients with blood cortisol measurements, the cortisol level was significantly high in the hyponatremia group.

Conclusions: Hyponatremia was less frequently associated with hyperglycemia, heart failure, renal failure, and other diseases that cause euvolemic hyponatremia; thus, PTB patients may have euvolemic hyponatremia due to SIAD. Administration of hypertonic saline or fluid restriction should be considered in PTB patients with hyponatremia.

Keywords: hyponatremia; pulmonary tuberculosis; syndrome of inappropriate antidiuresis.