Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
Department of Clinical Research, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
Crit Care. 2018 Feb 9;22(1):33. doi: 10.1186/s13054-018-1955-7.
Hypernatraemia is common in inpatients and is associated with substantial morbidity. Its differential diagnosis is challenging, and delayed treatment may have devastating consequences. The most important hormone for the regulation of water homeostasis is arginine vasopressin, and copeptin, the C-terminal portion of the precursor peptide of arginine vasopressin, might be a reliable new parameter with which to assess the underlying cause of hypernatraemia.
In this prospective, multicentre, observational study conducted in two tertiary referral centres in Switzerland, 92 patients with severe hyperosmolar hypernatraemia (Na > 155 mmol/L) were included. After a standardised diagnostic evaluation, the underlying cause of hypernatraemia was identified and copeptin levels were measured.
The most common aetiology of hypernatraemia was dehydration (DH) (n = 65 [71%]), followed by salt overload (SO) (n = 20 [22%]), central diabetes insipidus (CDI) (n = 5 [5%]) and nephrogenic diabetes insipidus (NDI) (n = 2 [2%]). Low urine osmolality was indicative for patients with CDI and NDI (P < 0.01). Patients with CDI had lower copeptin levels than patients with DH or SO (both P < 0.01) or those with NDI. Copeptin identified CDI with an AUC of 0.99 (95% CI 0.97-1.00), and a cut-off value ≤ 4.4pmol/L showed a sensitivity of 100% and a specificity of 99% to predict CDI. Similarly, urea values were lower in CDI than in DH or SO (P < 0.05 and P < 0.01, respectively) or NDI. The AUC for diagnosing CDI was 0.98 (95% CI 0.96-1.00), and a cut-off value < 5.05 mmol/L showed high specificity and sensitivity for the diagnosis of CDI (98% and 100%, respectively). Copeptin and urea could not differentiate hypernatraemia induced by DH from that induced by SO (P = 0.66 and P = 0.30, respectively).
Copeptin and urea reliably identify patients with CDI and are therefore helpful tools for therapeutic management in patients with severe hypernatraemia.
ClinicalTrials.gov, NCT01456533 . Registered on 20 October 2011.
高钠血症在住院患者中很常见，与大量发病率有关。其鉴别诊断具有挑战性，延迟治疗可能会产生毁灭性的后果。调节水稳态最重要的激素是精氨酸血管加压素，而精氨酸血管加压素前体肽的 C 端部分—— copeptin 可能是评估高钠血症潜在原因的可靠新参数。
在瑞士两家三级转诊中心进行的这项前瞻性、多中心、观察性研究中，纳入了 92 名严重高渗性高钠血症（Na>155mmol/L）患者。在进行标准化诊断评估后，确定高钠血症的根本原因并测量 copeptin 水平。
高钠血症最常见的病因是脱水（DH）（n=65[71%]），其次是盐过载（SO）（n=20[22%]）、中枢性尿崩症（CDI）（n=5[5%]）和肾性尿崩症（NDI）（n=2[2%]）。低尿渗透压提示 CDI 和 NDI 患者（P<0.01）。与 DH 或 SO（均 P<0.01）或 NDI 患者相比，CDI 患者的 copeptin 水平较低。Copeptin 对 CDI 的 AUC 为 0.99（95%CI 0.97-1.00），cutoff 值≤4.4pmol/L 对预测 CDI 的灵敏度为 100%，特异性为 99%。同样，CDI 患者的尿素值低于 DH 或 SO（P<0.05 和 P<0.01）或 NDI。诊断 CDI 的 AUC 为 0.98（95%CI 0.96-1.00），cutoff 值<5.05mmol/L 对 CDI 的诊断具有高特异性和灵敏度（分别为 98%和 100%）。Copeptin 和尿素不能区分由 DH 或 SO 引起的高钠血症（P=0.66 和 P=0.30）。
Copeptin 和尿素能可靠地识别 CDI 患者，因此是治疗严重高钠血症患者的有用工具。
ClinicalTrials.gov，NCT01456533。于 2011 年 10 月 20 日注册。
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