ECE2014 Poster Presentations Neuroendocrinology (27 abstracts)
Copeptin for the differential diagnosis and therapy management of hyponatremia in hospitalized patients – ‘The Co-MED-Study’
Nicole Nigro 1 , Bettina Winzeler 1 , Isabelle Suter-Widmer 1 , Philipp Schuetz 2 , Birsen Arici 1 , Martina Bally 2 , Claudine Blum 2 , Christian Nickel 3 , Roland Bingisser 3 , Andreas Bock 4 , Andreas Huber 5 , Beat Müller 2 & Mirjam Christ-Crain 1
1Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland, 2Department of Medical University Clinic and Divison of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Aarau, Switzerland, 3Department of Internal Medicine, University Hospital Basel, Basel, Switzerland, 4Department of Nephrology, Dialysis and Transplantation, Kantonsspital Aarau, Aarau, Switzerland, 5Central Laboratory, Kantonsspital Aarau, Aarau, Switzerland.
Background: Hyponatremia is common in hospitalized patients and its differential diagnosis and management challenging. An important mechanism is suppressed or adequately or inadequately secreted plasma arginine vasopressin (AVP). Therefore, plasma vasopressin levels may help in the differential diagnosis and in therapy management. Copeptin is secreted in an equimolar ratio to AVP and is more reliable to measure.
Methods: In this prospective observational multicentre study 298 consecutive patients admitted to the emergency department with severe hypoosmolar hyponatremia (Na<125 mmol/l) were included. After a standardized diagnostic evaluation patients were treated according to a diagnostic algorithm. Copeptin levels were compared between different aetiologies of hyponatremia and for prediction of therapeutic management.
Results: We found 24 patients (8%) with primary polydipsia, 72 patients (24%) had diuretic induced hyponatremia, 106 (36%) patients SIAD, 4 (1%) patients cortisol deficiency, 33 patients (11%) hypervolemic hyponatremia and 59 patients (20%) hypovolemic hyponatremia. Overall Copeptin levels discriminated between various aetiologies of severe hyponatremia (P<0.0001). Copeptin levels were higher in patients requiring saline infusion (n=139) as compared to patients requiring fluid restriction (n=159) (21.40 (8.00–65.60 pmol/L) vs 12.16 (IQR 5.13–28.15) pmol/l, P=0.0003). A copeptin level >56.8 pmol/l allowed a diagnosis of hypovolemic or diuretic induced hypovolemia requiring saline infusion with a specificity of 86%. Conversely, a copeptin level <4.4 pmol/l identified patients with need of fluid restriction with a specificity of 91%. In multivariate analysis copeptin, fractional uric acid excretion (FE uric acid) and volume status were independently associated with therapy management. The combination of these three factors showed a high prognostic accuracy for therapy management (AUC: 0.77 (95% 0.71–0.83).
Conclusion: Copeptin levels identify a subset of patients with a need of saline infusion or fluid restriction and may be a helpful new tool for therapeutic management. The best prediction of therapeutic management is achieved when combining copeptin, volume status and FEuric acid.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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