Background and aim: Cardiovascular disease (CVD) is the major cause of death in patients with type 2 diabetes mellitus (T2DM), making it of interest to attain efficient methods for prognostic purposes. We aimed to prospectively investigate the association between plasma copeptin and cardiovascular disease (CVD) in individuals with type 2 diabetes mellitus (T2DM), adjusting for mean 24-h ambulatory blood pressure, left ventricular mass index, and traditional cardio-metabolic risk factors.

Methods and results: A cohort of 523 patients with T2DM with complete data on copeptin, age, sex, body mass index (BMI), smoking, total cholesterol, eGFR, HbA1c, 24-h ambulatory systolic blood pressure (24-h SBP), and left ventricular mass index (LVMI) was derived from the Cardiovascular Risk Factors in Patients with Diabetes - a Prospective Study in Primary Care (CARDIPP) study. The incidence of major adverse cardiovascular events (MACE) and all-cause mortality were obtained from the Swedish Cause of Death Registry and the Inpatient Register. A Cox-proportional hazard analysis was conducted. Over 15 years, 120 patients had MACE, while 122 died of any cause. Patients with a copeptin level of ≥5.6 pmol/L exhibited a 2.05 hazard ratio (HR) for MACE (95 % CI 1.24-3.37, p < 0.005). However, after adjustment, no significant association with all-cause mortality (HR 1.30, 95 % CI 0.84-2.02, p = 0.238) was noted. These findings were independent of traditional cardio-metabolic risk factors, 24-h SBP, and LVMI.

Conclusions: Elevated copeptin levels (≥5.6 pmol/L) in patients with T2DM were independently associated with an increased risk of MACE. Measuring plasma copeptin may help identify high-risk T2DM patients.

Background: Individuals with diabetes are at higher risk for developing arterial disorders. The toe-brachial index (TBI) is associated with peripheral vascular disease, and aortic pulse-wave velocity (aPWV) is currently the gold standard for assessing arterial stiffness. High concentrations of plasma arginine vasopressin (AVP) preferentially stimulate V1a receptors, which affect the vascular bed and may contribute to cardiovascular (CV) complications. Copeptin, a more stable peptide of AVP, is co-secreted from the pituitary gland in equimolar amounts to AVP upon hemodynamic, osmotic, and other stress-related stimuli. Elevated levels of copeptin are potentially linked to vascular dysfunction.

Objective: To analyze the association of copeptin to TBI and aPWV as a marker of arterial disorder in patients with type 2 diabetes mellitus (T2D).

Methods: A cross-sectional analysis was conducted on 681 patients from the epidemiological study CARDIPP (Cardiovascular Risk Factors in Patients with Diabetes – a Prospective Study in Primary Care; ClinicalTrials.gov identifier NCT01049737) with data on copeptin, TBI, and aPWV. The relationship between the conventional cardiovascular risk factors and copeptin with TBI and aPWV were examined, respectively. Pearson correlation analysis and linear regression analyses were used.

Results: Copeptin correlated to TBI (r=-0.086, P=0.027) and aPWV (r=0.143, P<0,001). Copeptin was also negatively associated with TBI (β=-0.093, P=0.027) and aPWV (β=0.121, P=0.004) independently of age, sex, diabetes duration, BMI, smoking, previous cardiovascular diseases, HbA1c, HDL cholesterol, and estimated glomerular filtration rate.

Conclusion: Copeptin is independently associated with TBI and aPWV. Copeptin may play an important role in the development of arterial disorders. Measuring copeptin levels may be a simpler method and more efficient way to identify individuals at risk for arterial disorders compared to current methods such as TBI and aPWV.

Lustgas är ett populärt rusmedel bland unga som ofta felaktigt uppfattas som ofarligt.

Upprepad lustgasanvändning i berusningssyfte kan ge funktionell vitamin B12-brist med nervskador och trombo­emboliska komplikationer, vilket avhandlats i tidigare artiklar i Läkartidningen.

Även enstaka användning av lustgas i berusningssyfte kan dock medföra allvarliga risker, vilket illustreras i det aktuella fallet, där patienten drabbades av krampanfall och luftvägsruptur.

The use of nitrous oxide (N2O) as a recreational drug has significantly increased around the world in the last decade and has become a common occurrence in Sweden. Nitrous oxide can be easily accessed, purchased from party stores and online, and is legal in Sweden. There is a common misconception that nitrous oxide is harmless because it is used in healthcare. However, chronic nitrous oxide abuse can lead to a functional state of B12 deficiency with neurological and thromboembolic complications. The present case illustrates that recreational use of nitrous oxide may also lead to acute complications, including seizures and rupture of the airways.

Objectives There is currently limited understanding of the relationship between copeptin, the midregional portion of proadrenomedullin (MRproADM) and the midregional fragment of the N-terminal of proatrial natriuretic peptide (MRproANP), and arterial disorders. Toe brachial index (TBI) and aortic pulse wave velocity (aPWV) are established parameters for detecting arterial disorders. This study evaluated whether copeptin, MRproADM, and MRproANP were associated with TBI and aPWV in patients with type 2 diabetes with no history of cardiovascular disease (CVD).

Methods In the CARDIPP study, a cross-sectional analysis of 519 patients with type 2 diabetes aged 55–65 years with no history of CVD at baseline, had complete data on copeptin, MRproADM, MRproANP, TBI, and aPWV was performed. Linear regression analysis was used to investigate the associations between conventional CVD risk factors, copeptin, MRproADM, MRproANP, TBI, and aPWV.

Results Copeptin was associated with TBI (β–0.0020, CI–0.0035– (–0.0005), p = 0.010) and aPWV (β 0.023, CI 0.002–0.044, p = 0.035). These associations were independent of age, sex, diabetes duration, mean 24-hour ambulatory systolic blood pressure, glycated hemoglobin A1c, total cholesterol, estimated glomerular filtration rate, body mass index, and active smoking.

Conclusions Plasma copeptin may be a helpful surrogate for identifying individuals at higher risk for arterial disorders.

Cardiovascular disease (CVD) is the leading cause of death globally, and diabetes mellitus (DM) is increasingly prevalent worldwide. People with DM are at a higher risk of developing heart-related complications that can lead to serious health issues and death. Chest pain (CP) and shortness of breath (SOB) are common manifestations of cardiopulmonary disorders. These symptoms often prompt people to seek emergency medical care.

Risk stratification involves assessing a patient's probability of experiencing complications and premature death. Determining the necessary interventions to improve the patients' health outcomes is essential. Healthcare professionals encounter daily challenges in risk stratification. Identifying new and clinically relevant markers for improved risk stratification is crucial.

This thesis aims to assess whether blood biomarkers could predict the risk of adverse events and prognosis in emergency care patients with CP and/or SOB. Additionally, this work evaluates risk markers for identifying patients with higher risk of CVD and premature death in type 2 diabetes (T2DM) patients.

Papers I and II assessed the predictive values of copeptin, mid-regional pro-adrenomedullin (MRproADM), and mid-regional pro-atrial natriuretic peptide (MRproANP) as potential markers for risk stratification in emergency departments (ED). These studies were based on the ABBA population, a single-center observational study conducted at the Linköping Hospital ED.

In Paper I, age, sex, oxygen saturation, heart rate, National Early Warning Score (NEWS) category, and copeptin were found to be associated with admission to a hospital ward from the ED. Copeptin was found to have an added predictive value for admission compared to NEWS alone.

In Paper II, MRproADM levels >0.75 nmol/L and multimorbidity were significantly associated with readmission and/or death within 90 days. MRproADM improved the predictive value of readmission and/or death within 90 days compared to age, sex, and multimorbidity combined. 

Papers III, IV, and V were based on CARDIPP, a research program aimed at identifying markers for CVD in T2DM patients. This population-based study involved primary care patients aged 55−65, with a baseline survey conducted between 2005 and 2008. The cohort was monitored for CVD morbidity and mortality from a national registry.

In Paper III, patients with T2DM and low toe brachial index (TBI) had an increased risk of major adverse cardiovascular events (MACE) independent of arterial stiffness.

In Paper IV, we found that an increasing copeptin level was significantly associated with MACE. Patients with copeptin levels ≥5.6 pmol/L had an unfavorable risk for MACE, independent of traditional CVD risk factors and left ventricular mass index.

Paper V found that copeptin was associated with TBI and aortic pulse wave velocity (aPWV), both markers of arterial disorders, independent of traditional CVD risk factors.

In conclusion, early analysis of copeptin may be helpful for patient risk assessments. MRproADM and multimorbidity may predict the risk of readmission and/or death within 90 days. In patients with T2DM, low TBI, and elevated copeptin levels may serve as important indicators for increased risk of MACE. Copeptin may be a helpful surrogate for identifying individuals at higher risk of arterial disorders.

Nineteen Swedish professional organizations involved intrauma care have developed national recommendationsfor spinal motion restriction in trauma. Therecommendations describe the best practice in spinalmotion restriction for children, adults, and the elderly,both in prehospital care, in the emergency departmentand during transfer within and between hospitals. Thebackground to the recommendations is presented,together with implications for the widespreadeducational system Advanced Trauma Life Support(ATLS).

Under 1900-talet har traumasjukvården undergått en genomgripande utveckling. Under seklets första hälft blev trafikolyckor allt vanligare, vilket successivt ledde till ett mer strukturerat omhändertagande av patienter med allvarliga skador, inkluderande kotpelarskador.

ATLS (advanced trauma life support), ett nytt sätt att ta hand om patienter med livshotande skador, utvecklades sedan ortopeden James Styner påpekade behovet av systemförändringar inom den initiala traumavården 1976 [1] och presenterades två år senare. Konceptet innebär bland annat att traumapatienter rutinmässigt ska handläggas efter ABCDE-­principen, som innefattar att de ska säkras i ryggläge på en hård bräda med en stel eller halvstel nackkrage. ATLS är väl inarbetat i svensk sjukvård, och kurserna är obligatoriska för de läkarspecialiteter som är mest delaktiga i traumasjukvården. Även andra utbildningar inom traumasjukvård, såsom ATSS (akut traumasjukvård för sjuksköterskor), TNCC (trauma nursing core course) och det prehospitala PHTLS (prehospital trauma life support) är upplagda på liknande vis.