title: Hyponatremia and risk factors for death in human visceral leishmaniasis: new insights from a cross-sectional study in Brazil.
abstract: Visceral 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.
  
  
  
  This 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.
  
  
  
  A 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.
  
  
  
  Higher 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.
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil. ef.daher@uol.com.br.|Medical Sciences Graduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil. ef.daher@uol.com.br.
authors.forename: Elizabeth De Francesco
authors.initials: EF
authors.lastname: Daher
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil.
authors.forename: Douglas de Sousa
authors.initials: DS
authors.lastname: Soares
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil.
authors.forename: Sérgio Luiz Arruda Parente
authors.initials: SL
authors.lastname: Filho
authors.affiliation: Pharmacology Graduate Program, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Gdayllon Cavalcante
authors.initials: GC
authors.lastname: Meneses
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil.
authors.forename: Tainá Veras de Sandes
authors.initials: TV
authors.lastname: Freitas
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil.
authors.forename: Tacyano Tavares
authors.initials: TT
authors.lastname: Leite
authors.affiliation: School of Medicine, Public Health Graduate Program, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil.
authors.forename: Geraldo Bezerra
authors.initials: GB
authors.lastname: da Silva Junior
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology / Q000209:etiology*; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases / Q000150:complications / Q000401:mortality*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Hypoalbuminemia; Hyponatremia; Kala-azar; Mortality; Predictor factors; Visceral leishmaniasis