Moderate/Severe hyponatremia increases the risk of death among hospitalized Chinese human immunodeficiency virus/acquired immunodeficiency syndrome patients

Lijun Xu; Hanhui Ye; Fan Huang; Zongxing Yang; Biao Zhu; Yan Xu; Yunqing Qiu; Lanjuan Li

doi:10.1371/journal.pone.0111077

Moderate/Severe hyponatremia increases the risk of death among hospitalized Chinese human immunodeficiency virus/acquired immunodeficiency syndrome patients

PLoS One. 2014 Oct 31;9(10):e111077. doi: 10.1371/journal.pone.0111077. eCollection 2014.

Authors

Lijun Xu¹, Hanhui Ye², Fan Huang³, Zongxing Yang⁴, Biao Zhu¹, Yan Xu⁴, Yunqing Qiu¹, Lanjuan Li¹

Affiliations

¹ The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China.
² Clinical Center of HIV/AIDS, Fuzhou Infectious Disease Hospital, Fujian Medical University, Fuzhou City, China.
³ Department of Infectious Diseases, Jianxin Hospital of Fujian Province, Fuzhou City, China.
⁴ The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China.

Abstract

Objectives: To evaluate whether the serum sodium concentration is associated with the progression and long-term prognosis of Chinese HIV/AIDS patients.

Methods: Three hundred and eighty seven hospitalized patients were recruited into this retrospective cohort study. The strata of serum sodium concentration were moderate/severe hyponatremia, mild hyponatremia and normonatremia. Disease progression was estimated using CD4 counts and the WHO clinical stage. Correlation analysis was used to evaluate the serum sodium concentration with disease progression. The Kaplan-Meier method and the Cox proportional hazards model were used to analyze the effect of different serum sodium levels on survival.

Results: In this study 206 patients (53.2%) had hyponatremia, including 10.6% patients with moderate/severe hyponatremia and 42.6% with mild hyponatremia. The serum sodium concentration was significantly correlated with the HIV/AIDS progression (P<0.001). During the follow-up, 100 patients (25.6%) died. The cumulative survival rates of HIV/AIDS patients were 47.8% ± 8.5% in patients with moderate/severe hyponatremia, 59.8% ± 5.0% with mild hyponatremia and 79.9% ± 3.4% with normonatremia (log-rank P<0.001). After adjusting for sex, age, WHO stage, CD4 count, hemoglobin and albumin, the relative hazard was 3.5 (95% CI: 1.9-6.5) for patients with moderate/severe hyponatremia (P<0.001), and 1.5 (95% CI: 0.9-2.4) for those with mild hyponatremia (P = 0.161), compared with normonatremic patients.

Conclusions: The serum sodium level is closely correlated with the severity of patients. Only moderate/severe hyponatremia affects the prognosis of Chinese HIV/AIDS patients. Earlier intensive medical managements(including HAART)are necessary to increase the survival rates of Chinese HIV/AIDS patients with moderate/severe hyponatremia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acquired Immunodeficiency Syndrome / blood*
Acquired Immunodeficiency Syndrome / mortality
Adult
China / epidemiology
Disease Progression
Female
Hospital Mortality
Humans
Hyponatremia / blood*
Hyponatremia / mortality
Male
Middle Aged
Retrospective Studies
Risk Factors
Sodium / blood
Survival Rate

Substances

Sodium

Grants and funding

This research was supported by the 12th Five-Year Significant New Drugs Creation Plan of the Ministry of Science and Technology of China (Grant Number 2011ZX09302-003-03). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.