AEGiS-15IAC: Does hyponatremia have a predictive value in the diagnosis of extra-pulmonary tuberculosis in HIV-1 infected patients in Cambodia?

15th International AIDS Conference


Bangkok, Thailand - July 11-16, 2004

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Does hyponatremia have a predictive value in the diagnosis of extra-pulmonary tuberculosis in HIV-1 infected patients in Cambodia?

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. B10358)

Lynen LM, Phan S, Suos P, Thai S, Harwell J, Boelaert M
Institute of Tropical Medicine, Antwerp, Belgium

BACKGROUND: Hyponatremia is frequent in hospitalized HIV patients. This seems particularly true for HIV patients with extra-pulmonary tuberculosis (EPTB). EPTB is difficult to diagnose in resource-poor settings. We studied the predictive value of hyponatremia for the diagnosis of EPTB in a cohort of HIV patients.

METHODS: Retrospective review of charts of all HIV patients hospitalized in the Sihanouk Hospital Center of HOPE between January 1998 and December 2001. The presence of hyponatremia (sodium< 135 meq/L) at admission and the discharge diagnosis were recorded.

RESULTS: A total of 144 files were examined. 5 files were excluded because of incomplete data. 53/139 patients had hyponatremia (38%). 48 patients had EPTB (34%). Multiple logistic regression analysis showed a significant correlation between hyponatremia and the diagnosis of EPTB (p< 0.001), adjusting for hypoxia, creatinine level, cotrimoxazole therapy, PCP infection, and other CNS infection. Sodium< 135 Meq/l had a sensitivity of 60.4% (95% CI: 46.3 - 73.0) and a specificity of 73.6% (95%CI: 63.8 - 81.6) for the diagnosis of EPTB in our patient cohort. The predictive values of a positive and negative test were respectively 54.7% and 76.1%. The positive likelihood ratio of EPTB in the presence of hyponatremia was 2.29 (95% CI: 1.52-3.46) and the diagnostic odds ratio 4.26 (95% CI: 2.03 - 8.96). Conclusion In HIV patients the presence of hyponatremia is significantly correlated with the diagnosis of EPTB (p<0.001). However, this association is weak. Therefore, the presence of hyponatremia should raise the suspicion of EPTB but cannot be used as a decisive argument in the diagnosis of EPTB in HIV/AIDS patients.

Keywords: AEGIS, Tuberculosis, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Infection, Odds Ratio, Cambodia, Humans, diagnosis, pathogenicity, Ethics

040711
B10358

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