Müller B, Morgenthaler N, Stolz D, Schuetz P, Müller C, Bingisser R, Bergmann A, Tamm M, Christ-Crain M
University Hospital Basel, Switzerland.
Eur J Clin Invest. 2007 Feb;37(2):145-52. doi: 10.1111/j.1365-2362.2007.01762.x.
Vasopressin has haemodynamic as well as osmoregulatory effects, and reflects the individual stress response. Copeptin is co-synthesized with vasopressin, directly mirroring vasopressin levels, but is more stable in plasma and serum. Both levels are increased in patients with septic shock. Lower respiratory tract infections (LRTI) are a precursor of sepsis. Thus, we investigated circulating levels and the prognostic use of copeptin for the severity and outcome in patients with LRTI.
Five hundred and forty-five consecutive patients with LRTI and 50 healthy controls were evaluated. Serum copeptin levels were measured with a new chemiluminescent sandwich immunoassay.
Of the 545 patients, 373 had community-acquired pneumonia (CAP), 60 acute exacerbations of chronic obstructive pulmonary disease (COPD), 59 acute bronchitis, 13 exacerbations of asthma and 40 other final diagnoses. Copeptin levels were significantly higher in patients with LRTI as compared to controls (P < 0.001) with highest levels in patients with CAP. Copeptin levels increased with increasing severity of CAP, as classified by the pneumonia severity index (PSI) (P < 0.001). In patients who died, copeptin levels on admission were significantly higher as compared to levels in survivors [70.0 (28.8-149.0) vs. 24.3 (10.8-43.8) pmol L(-1), P < 0.001]. The area under the receiver operating curve (AUC) for survival was 0.75 for copeptin, which was significantly higher as compared to C-reactive protein (AUC 0.61, P = 0.01), leukocyte count (AUC 0.59, P = 0.01) and similar to procalcitonin (AUC 0.68, P = 0.21).
Copeptin levels are increased with increasing severity of LRTI namely in patients with CAP and unfavourable outcome. Copeptin levels, as a novel biomarker, might be a useful tool in the risk stratification of patients with LRTI.
血管加压素具有血流动力学及渗透调节作用，反映个体应激反应。 copeptin与血管加压素共同合成，直接反映血管加压素水平，但在血浆和血清中更稳定。脓毒性休克患者这两者水平均升高。下呼吸道感染（LRTI）是脓毒症的前驱症状。因此，我们研究了LRTI患者中copeptin的循环水平及其对疾病严重程度和预后的预测价值。
对545例连续的LRTI患者和50例健康对照者进行评估。采用新型化学发光夹心免疫分析法检测血清copeptin水平。
545例患者中，373例为社区获得性肺炎（CAP），60例为慢性阻塞性肺疾病急性加重（COPD），59例为急性支气管炎，13例为哮喘急性发作，40例为其他最终诊断。与对照组相比，LRTI患者的copeptin水平显著更高（P < 0.001），其中CAP患者水平最高。根据肺炎严重程度指数（PSI）分类，CAP严重程度增加时，copeptin水平升高（P < 0.001）。死亡患者入院时的copeptin水平显著高于存活患者[70.0（28.8 - 149.0）对24.3（10.8 - 43.8）pmol L(-1)，P < 0.001]。copeptin预测生存的受试者工作特征曲线下面积（AUC）为0.75，显著高于C反应蛋白（AUC 0.61，P = 0.01）、白细胞计数（AUC 0.59，P = 0.01），与降钙素原相似（AUC 0.68，P = 0.21）。
LRTI严重程度增加时，即CAP患者及预后不良患者中，copeptin水平升高。copeptin水平作为一种新型生物标志物，可能是LRTI患者风险分层的有用工具。
