Table 1.
Clinical, laboratory and radiologic parameters of pediatric TBM with and without varying severity of serum hyponatremia.
|
All patients (n = 481) n/N (%)* |
Without hyponatermia (n = 127) n/N (%) |
Mild hyponatremia (n = 169) n/N (%) |
Moderate hyponatremia (n = 146) n/N (%) |
Severe hyponatremia (n = 29) n/N (%) |
Comparison between hyponatremia categories |
||
|---|---|---|---|---|---|---|---|
| p -value | |||||||
| Definite TBM | 101/481 (21.0) | 19/127 (15.0) | 34/169 (20.1) | 32/146 (21.9) | 4/29 (13.8) | 0.33 | |
| Male gender | 239/481 (49.7) | 57/127 (44.9) | 82/169 (48.5) | 80/146 (54.8) | 15/29 (51.7) | 0.76 | |
| Median age in months | 28.0: IQR 14.0–48.0 | 23.0: IQR 12.0–48.0 | 30.0: IQR 16.0–49.0 | 29.0: IQR 16.0–49.0 | 28.0: IQR 24.0–44.5 | 0.94# | |
| Vomiting | 223/421 (53.0) | 55/112 (49.1) | 78/148 (52.7) | 70/129 (54.3) | 14/25 (56.0) | 0.87 | |
| Fever | 303/448 (67.6) | 90/120 (75.0) | 101/156 (64.7) | 91/137 (66.4) | 17/27 (63.0) | 0.73 | |
| Seizures | 193/421 (45.8) | 49/112 (43.8) | 67/148 (45.3) | 59/129 (45.7) | 13/25 (52.0) | 0.57 | |
| Headache | 107/421 (25.4) | 28/112 (25.0) | 40/148 (27.0) | 34/129 (26.4) | 5/25 (20.0) | 0.46 | |
| Symptom duration > 5 days | 401/481 (83.4) | 111/127 (87.4) | 138/169 (81.7) | 120/146 (82.2) | 24/29 (82.8) | 0.94 | |
| HIV positive | 12/233 (5.2) | 3/71 (4.2) | 4/83 (4.8) | 3/62 (4.8) | 2/12 (16.7) | 0.14 | |
| Faltering weight gain or weight loss | 208/477 (43.6) | 49/119 (41.2) | 76/157 (48.4) | 57/136 (41.9) | 10/27 (37.0) | 0.69 | |
| GCS <15 | 357/454 (78.6) | 90/119 (75.6) | 125/160 (78.1) | 109/139 (78.4) | 24/27 (88.9) | 0.20 | |
| TBM severity | Stage I | 13/454 (2.9) | 7/119 (5.5) | 4/160 (2.5) | 2/139 (1.4) | 0 | |
| Stage IIa | 84/454(18.5) | 21/119 (17.6) | 32/160 (20.0) | 28/139 (20.1) | 3/27 (11.1) | 0.28 | |
| Stage IIb | 124/454 (27.3) | 37/119 (31.1) | 44/160 (27.5) | 36/139 (25.9) | 6/27 (22.2) | 0.69 | |
| Stage III | 233/454 (51.3) | 54/119 (45.4) | 80/160 (50.0) | 73/139 (52.5) | 18/27 (66.7) | 0.18 | |
| Stroke (hemiparesis and/or radiologic infarction) | 301/445 (67.6) | 77/119 (64.7) | 108/160 (67.5) | 92/139 (66.2) | 24/27 (88.9) | 0.03 | |
| Cranial nerve palsy | 135/454 (29.7) | 29/119 (24.4) | 48/160 (30.0) | 46/139 (33.1) | 12/27 (44.4) | 0.26 | |
| Raised ICP symptoms | 98/453 (21.6) | 28/119 (23.5) | 31/160 (19.4) | 30/138 (21.7) | 7/27 (25.9) | 0.63 | |
| Brainstem dysfunction | 159/454 (35.0) | 29/119 (24.4) | 53/160 (33.1) | 53/139 (38.1) | 19/27 (70.4) | <0.01 | |
| Median serum sodium in mmol/L (IQR) | 132.0 (127.0–135.0) | ||||||
| CSF leucocytes 10–500 cells/L | 402/454 (88.5) | 107/119 (89.9) | 146/160 (91.3) | 121/139 (87.1) | 23/27 (85.2) | 0.79 | |
| CSF lymphocyte predominance | 373/454 (82.2) | 101/119 (84.9) | 131/160 (81.9) | 115/139 (82.7) | 22/27 (81.5) | 0.88 | |
| CSF protein concentration >1 g/L | 334/449 (74.4) | 85/116 (73.3) | 109/159 (68.6) | 114/138 (82.6) | 19/27 (70.4) | 0.15 | |
| CSF glucose <2.2 mmol/L or <50% of blood level | 297/441 (67.3) | 75/116 (64.7) | 105/156 (67.3) | 95/134 (70.9) | 19/26 (73.1) | 0.82 | |
| Basal meningeal enhancement | 360/435 (82.8) | 97/114 (85.1) | 120/154 (77.9) | 113/132 (85.6) | 21/26 (80.8) | 0.53 | |
| Tuberculoma (s) | 60/435(13.8) | 19/114 (16.7) | 20/154 (13.0) | 17/132 (12.9) | 3/26 (11.5) | 0.85 | |
| Hydrocephalus | 400/435 (92.0) | 99/114 (86.8) | 147/154 (95.5) | 122/132 (92.4) | 24/26 (92.3) | 0.98 | |
| Non-communicating hydrocephalus | 116/494 (29.4) | 25/97 (25.8) | 40/145 (27.6) | 43/122 (35.2) | 8/23 (34.8) | 0.11 | |
| Death | 34/378 (9.0) | 5/97 (5.2) | 13/133 (9.8) | 13/117 (11.1) | 3/23 (13.0) | 0.79 |
*
Includes patients with serum sodium >145 mmol/L.
#
Comparison for mean age.
Zero stage I TBM with severe hyponatremia.
TBM, tuberculous meningitis; IQR, interquartile range; HIV, human immunodeficiency virus; GCS, glasgow coma scale; ICP, intracranial pressure; CSF, cerebrospinal fluid. The bold values reflect significant p value of ≤.