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Randomized Controlled Trial

Hyponatremia and anti-diuretic hormone in Legionnaires' disease

Philipp Schuetz et al. BMC Infect Dis. .

Abstract

Background: Medical textbooks often list Legionnaires' disease as a differential diagnosis of the syndrome of inappropriate secretion of anti-diuretic hormone (ADH) (SIADH), but evidence supporting this association is largely lacking. We tested the hypothesis whether hyponatremia in patients with Legionnaires' disease would be caused by increased CT-ProVasopressin.

Methods: We measured CT-ProVasopressin and sodium levels in a prospective cohort of 873 pneumonia patients from a previous multicentre study with 27 patients having positive antigen tests for Legionella pneumophila.

Results: Patients with Legionnaires' disease more frequently had low sodium levels (Na < 130 mmol/L) (44.4% vs 8.2%, p < 0.01), but similar mean CT-ProVasopressin levels (pmol/l) (39.4 [±7] vs 51.2 [±2.7], p = 0.43) as compared to patients with pneumonia of other etiologies. In patients with Legionnaires' disease, CT-ProVasopressin levels showed a positive correlation with sodium (r = 0.42, p < 0.05). Independent of pneumonia etiology, CT-ProVasopressin correlated significantly with the pneumonia severity index (r = 0.56, p < 0.05), ICU admission (adjusted odds ratio per decile, 95% CI) (1.6, 1.2 - 2.0), and 30-day-mortality (1.8, 1.3 - 2.4).

Conclusion: While Legionnaires' disease was associated with hyponatremia, no concurrent increase in CT-ProVasopressin levels was found, which argues against elevated ADH levels as the causal pathway to hyponatremia. Rather, Vasopressin precursors were upregulated as response to stress in severe disease, which seems to overrule the osmoregulatory regulation of ADH.

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Figures

Figure 1
Figure 1
Admission sodium (A) and CT-ProVasopressin (B) levels in Legionnaires’ disease, and CAP of other (unknown) etiology.Legend: The lines indicate median values, the boxes indicate upper and lower quartiles of the data, while the whiskers indicate the minimum and maximum values. * p < 0.01.
Figure 2
Figure 2
Correlation of sodium (A) and CT-ProVasopressin (B) levels in patients with CAP of other/unknown etiology and Legionnaires’ disease.
Figure 3
Figure 3
Plasma sodium (A) and CT-ProVasopressin (B) according to CAP severity assessed with the CURB65 score in patients with Legionnaires’ disease (dark grey) and patients with other CAP aetiology (light grey).

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