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Medscape
07-07-2025
- Health
- Medscape
Copeptin as a Prognostic Marker in Emergency Hyponatremia
TOPLINE: Measuring copeptin levels in patients with hypotonic hyponatremia on emergency department (ED) admission provided key diagnostic insights. The copeptin to urinary sodium ratio more accurately predicted preserved extracellular fluid (ECF) than urinary sodium alone, and higher copeptin levels were linked to an increased risk for mortality. METHODOLOGY: Hypotonic hyponatremia is frequently observed during hospitalization and can increase the risk for mortality; in this context, copeptin, the C-terminal portion of the arginine vasopressin precursor, has emerged as a valuable marker for predicting complications associated with hypotonic hyponatremia. Researchers reported findings from a prospective cohort study conducted between June 2018 and August 2019 at a hospital in Italy, evaluating the accuracy of copeptin in identifying preserved ECF patterns and its predictive value in critically ill patients admitted to the ED. They included 84 adult patients (median age, 79 years; 47 women), in whom hyponatremia was confirmed by both direct and indirect ion-selective electrode assays after glucose correction; severe hyponatremia was observed in 34.5% of patients. Information on vital signs, ultrasound, medical history, and comorbidities was recorded, and pretreatment blood and urine samples were collected for laboratory analyses. ECF status was reassessed after discharge by three independent endocrinologists; in-hospital mortality and 6-month mortality were also evaluated. TAKEAWAY: Reduced ECF, increased ECF, and preserved ECF were reported in 28 patients each. A ratio of copeptin to urinary sodium of ≤ 29.5 pmol/mmol × 100 increased the likelihood of preserved ECF by more than fourfold (adjusted odds ratio, 4.28; P = .026), outperforming standard urinary sodium measurements (difference in area under the curve when the urinary sodium cut-off was > 30 mmol/L, 0.177; P = .013). Copeptin levels were positively associated with increased risks for in-hospital mortality (P < .0001) and 6-month mortality (P = .02), with levels above 13.6 pmol/L associated with a more than fourfold increased risk for 6-month mortality (hazard ratio, 4.507; P = .0001). Additional predictors of 6-month mortality included levels of N-terminal prohormone of brain natriuretic peptide (P = .031) and comorbidity burden (P = .009). IN PRACTICE: 'It is important to note that our results do not suggest replacing copeptin with other established clinical and biochemical evaluations routinely performed in emergency care, such as s-K [serum potassium] or NT-proBNP [N-terminal prohormone of brain natriuretic peptide] levels, when clinically appropriate. Rather, the aim of adjusting copeptin's predictive value for these common parameters in our analysis was to confirm its independent contribution,' the authors wrote. SOURCE: This study was led by Alessandro Maria Berton, Department of Medical Sciences, University of Turin, Turin, Italy. It was published online in The Journal of Clinical Endocrinology and Metabolism. LIMITATIONS: Patient recruitment was restricted to daytime hours and weekdays, thus limiting the generalizability. Certain analytes were not available for all patients during ED evaluation. Additional urinary parameters such as urine chloride, uric acid fractional excretion, and potassium levels were not compared with the copeptin/urinary sodium index. DISCLOSURES: This study received no specific grant from any funding agency. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
12-05-2025
- Health
- Medscape
Does Eating Nuts, Seed, Corn Raise Diverticulitis Risk?
Women who consumed nuts, seeds, or corn had no increased risk for diverticulitis, contrary to historical data suggesting these foods may trigger the condition. METHODOLOGY: Although prior research has challenged the historical assumption that intake of nuts, seeds, and corn precipitates diverticulitis, it was conducted exclusively in men and did not control for overall diet quality. Researchers analyzed data from 29,916 women aged 35-74 years enrolled between 2003 and 2009 in an ongoing prospective cohort study. All participants were free of inflammatory bowel disease, diverticulitis, and cancer at baseline. Diverticulitis was self-reported, and food frequency questionnaires were used to calculate dietary index scores and intake of nuts, seeds, and corn. Associations between dietary factors and diverticulitis risk were evaluated using Cox proportional hazards models adjusted for demographic and health covariates. TAKEAWAY: After a mean follow-up of 13.9 years, 1531 incident cases of diverticulitis were identified. Women with diverticulitis tended to have older age, current or former smoking habit, heavy alcohol usage, and overweight. Intake of peanuts, nuts, and seeds was not associated with an increased risk for diverticulitis (adjusted hazard ratio [aHR] for highest vs lowest quartile, 1.07), nor was intake of fresh fruits with edible seeds (aHR, 1.06). Corn intake was inversely associated with diverticulitis risk, with those in the highest quartile having a lower risk (aHR, 0.86). Women in the highest quartile of adherence to the Dietary Approaches to Stop Hypertension diet had a 23% reduced risk for diverticulitis (aHR, 0.77), with similar reductions for the Healthy Eating Index (aHR, 0.78) and Alternative Healthy Eating Index (aHR, 0.81), and a nonsignificant trend for the Alternative Mediterranean diet (aHR, 0.91). No association was found between any dietary component or pattern and the risk of developing diverticulosis. IN PRACTICE: 'Our findings refute the widely held belief that dietary intake of particulate matter should be avoided to prevent diverticulitis,' the authors wrote. 'Diets with widely documented health benefits are also associated with a reduced risk for incident diverticulitis.' SOURCE: The study, with first author Trevor Barlowe, MD, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, was study published online in Annals of Internal Medicine . LIMITATIONS: The study was observational and could not establish causality. Diverticulitis diagnoses were self-reported, introducing risk for misclassification. Although the analyses were adjusted for multiple confounders, the presence of bias from unmeasured confounders is possible. DISCLOSURES: Study funding was provided by the National Institutes of Health. The authors disclosed having no relevant conflicts of interest. Credit Lead image: Pakhnyushchyy/Dreamstime Medscape Medical News © 2025 WebMD, LLC Cite this: Does Eating Nuts, Seed, Corn Raise Diverticulitis Risk? - Medscape - May 12, 2025.
