Reassessing the Role of Copeptin in Emergency Department Admissions for Hypotonic Hyponatremia
Authors' conclusion
Measuring copeptin on ED admission in hypotonic hyponatremia aids diagnosis and mortality prediction. The copeptin/u-Na index more accurately identifies preserved ECF than the standard u-Na cutoff.
Study context
- Population
- Adults with hypotonic hyponatremia (confirmed by direct and indirect ion-selective electrode assay after glucose correction) admitted to a medical emergency department (ED); IPSO-URG, June 2018 to August 201984 analysed
- Participants
- 123 adults
- Outcome
- Copeptin's effectiveness in evaluating ECF volume (preserved ECF) and its predictive value (in-hospital and 6-month mortality)
Methodological detailssingle tertiary centre, consecutive sample, 6-month follow-up, extracellular fluid (ECF) status reassessed by 3 endocrinologists blinded to copeptin
- Single tertiary centre
- Consecutive sample
- 6-month follow-up
- ECF status reassessed by 3 endocrinologists blinded to copeptin
Main finding
As reported in the abstract
Preserved ECF: copeptin-to-urinary sodium (u-Na) ratio ≤29.5 pmol/mmol
Copeptin/u-Na ratio ≤29.5 pmol/mmol and likelihood of preserved ECF, OR
4.28
P = .026
Copeptin/u-Na ratio vs standard u-Na, AUC difference
0.177
P = .013
Observational data: associations, not effects.
Further findings
In-hospital mortality
- Copeptin predicted in-hospital mortality, HR
- 1.005
- Optimal copeptin cutoff >60.1 pmol/L
- P = 0.0005
6-month mortality
- Copeptin, HR
- 1.005; P = .02
- N-terminal prohormone of brain natriuretic peptide, HR
- 1.004; P = .031
- Comorbidity burden, HR
- 1.207; P = .009
- Copeptin >13.6 pmol/L, HR
- 4.507; P = .0001
Original publication
Reassessing the Role of Copeptin in Emergency Department Admissions for Hypotonic Hyponatremia. J Clin Endocrinol Metab. Published 3 May 2025. doi:10.
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