Dysnatremia, vasopressin, atrial natriuretic peptide and mortality in patients with community-acquired pneumonia

Krüger, Stefan; Ewig, Santiago; Giersdorf, Sven; Hartmann, Oliver; Frechen, Dirk; Rohde, Gernot; Suttorp, Norbert; Welte, Tobias

doi:10.1016/j.rmed.2014.09.014

Cited by 52 publications

(52 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…ADM and AVP levels were also analyzed with the LMM method. Biological relevance of our results is supported by other studies, where similar changes in AVP and ADM levels were found in other diseases [36,37]. Moreover Castellano et al found that adrenomedullin gene induced more than 1.5-fold in C1-INH-HAE patients during attacks [38].…”

Section: Discussionsupporting

confidence: 90%

Novel Vasoregulatory Aspects of Hereditary Angioedema: the Role of Arginine Vasopressin, Adrenomedullin and Endothelin-1

et al. 2016

View full text Add to dashboard Cite

The elevation of bradykinin (BK) level during attacks of hereditary angioedema due to C1-Inhibitor deficiency (C1-INH-HAE) is well known. We previously demonstrated that endothelin-1 (ET-1) level also increases during C1-INH-HAE attacks. Although BK and ET-1 are both potent vasoactive peptides, the vasoregulatory aspect of the pathomechanism of C1-INH-HAE has not yet been investigated. Hence we studied the levels of vasoactive peptides in controls and in C1-INH-HAE patients, as well as evaluated their changes during C1-INH-HAE attacks. The levels of arginine vasopressin (AVP), adrenomedullin (ADM) and ET-1 were measured in the plasma of 100 C1-INH-HAE patients in inter-attack periods and of 111 control subjects, using BRAHMS Kryptor technologies. In 18 of the 100 C1-INH-HAE patients, the levels of vasoactive peptides were compared in blood samples obtained during attacks, or in inter-attack periods. AVP, ADM and ET-1 levels were similar in inter-attack samples from C1-INH-HAE patients and in the samples of controls, although cardiovascular risk has an effect on the levels of vasoactive peptides in both groups. The levels of all three vasoactive peptides increased during C1-INH-HAE attacks. Moreover, the levels of ET-1 and ADM as well as their changes during attacks were significantly correlated. This study demonstrated that vascular regulation by vasoactive peptides is affected during C1-INH-HAE attacks. Our results suggest that the cooperation of several vasoactive peptides may be necessary to counterbalance the actions of excess BK, and to terminate the attacks. This may reveal a novel pathophysiological aspect of C1-INH-HAE.

show abstract

Section: Discussionsupporting

confidence: 90%

Novel Vasoregulatory Aspects of Hereditary Angioedema: the Role of Arginine Vasopressin, Adrenomedullin and Endothelin-1

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Hyponatraemia occurs in 8%‐31% of adult patients with CAP with higher incidence in children (27%‐45%) and Legionella pneumonia(44%) . Hyponatraemia in CAP is usually mild (130‐134 mmol/L) and asymptomatic, yet epidemiological data consistently demonstrate increased mortality, more frequent ITU admission, and prolonged hospital stay, in patients with CAP and hyponatraemia. Consequently, hyponatraemia in CAP has been associated with an increase in hospital costs …”

Section: Introductionmentioning

confidence: 99%

Hyponatraemia in patients with community‐acquired pneumonia; prevalence and aetiology, and natural history of SIAD

Cuesta

Slattery

Goulden

et al. 2019

Clinical Endocrinology

View full text Add to dashboard Cite

Summary Objective Hyponatraemia is common in community‐acquired pneumonia (CAP) and is associated with increased mortality. The mechanism of hyponatraemia in CAP is not completely understood and treatment is therefore ill‐defined. We aimed to define the causation of hyponatraemia in CAP. Design Prospective, single‐centre, observational study of all patients with CAP and hyponatraemia (≤ 130 mmol/L) during a 9‐month period. Patients The prevalence of each subtype of hyponatraemia, and the associated mortality, was determined in 143 admissions with CAP (Study 1). A sub‐cohort of patients with SIAD (n = 10) was prospectively followed, to document the natural history of SIAD associated with CAP (Study 2). Measurements In Study 2, blood and urine were collected on day 1, 3, 5 and 7 following admission for measurement of plasma vasopressin, sodium, osmolality and urine osmolality. Results In study 1, 143/1723(8.3%) of CAP patients had hyponatraemia (≤130 mmol/L). About 66 had SIAD (46%), 60(42%) had hypovolaemic hyponatraemia (HON), 13(9%) had hypervolaemic hyponatraemia (HEN) and 4(3%) patients had hyponatraemia due to glucocorticoid hormone deficiency. Mortality was higher in the HEN than in the HON, SIAD or normonatraemic groups (P < 0.01). In Study 2, plasma sodium concentration normalized in 8/10 (80%) by day 7. Two patients with persistent hyponatraemia were discovered to have underlying bronchiectasis. Conclusions Hyponatraemia in CAP is most commonly secondary to SIAD or hypovolaemia. HEN is less common, but has worse prognosis. Prospective observation demonstrates that in SIAD, plasma AVP and sodium concentrations normalize with antimicrobials; failure of reversal of suggests underlying lung disease, such as bronchiectasis.

show abstract

“…A recent German study reported a high incidence of hyponatremia (31.8%) among patients with community-acquired pneumonia [6]. The degree of hyponatremia severity seemed to correlate with the patients' comorbidities (such as chronic heart failure, chronic renal disease, diabetes mellitus, and malignancies), higher severity of pneumonia, and higher inflammatory biomarkers.…”

Section: Discussionmentioning

confidence: 99%

“…However, the association of these comorbidities with sodium levels was weak and disappeared after inclusion in a multivariate model. The relationship of hyponatremia and higher pneumonia severity probably reflects the presence of hypovolemia, severe sepsis, and subsequent activation of vasopressin and natriuretic peptides secretion [6]. The decrease in the ability to reduce urine osmolality and excrete water loads and the increasing levels of ADH in the absence of antibiotic treatment [7] might be incriminated in pneumonia-induced hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

Severe Hyponatremia due to Levofloxacin Treatment for Pseudomonas aeruginosa Community-Acquired Pneumonia in a Patient with Oropharyngeal Cancer

Mocan¹,

Blaga

2016

Case Reports in Medicine

View full text Add to dashboard Cite

Hyponatremia (serum Na levels of <135 mEq/L) is the most common electrolyte imbalance encountered in clinical practice, affecting up to 15–28% of hospitalized patients. This case report refers to a middle-aged man with severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion related to four possible etiological factors: glossopharyngeal squamous cell carcinoma, cisplatin treatment, right basal pneumonia with Pseudomonas aeruginosa, and the treatment with Levofloxacin. This case report discusses a rare complication of common conditions and of a common treatment. To our knowledge this is the first case of hyponatremia related to Levofloxacin and the second related to fluoroquinolones.

show abstract

Dysnatremia, vasopressin, atrial natriuretic peptide and mortality in patients with community-acquired pneumonia

Cited by 52 publications

References 35 publications

Novel Vasoregulatory Aspects of Hereditary Angioedema: the Role of Arginine Vasopressin, Adrenomedullin and Endothelin-1

Novel Vasoregulatory Aspects of Hereditary Angioedema: the Role of Arginine Vasopressin, Adrenomedullin and Endothelin-1

Hyponatraemia in patients with community‐acquired pneumonia; prevalence and aetiology, and natural history of SIAD

Severe Hyponatremia due to Levofloxacin Treatment for Pseudomonas aeruginosa Community-Acquired Pneumonia in a Patient with Oropharyngeal Cancer

Contact Info

Product

Resources

About