Dong Xiao-Qiao, Huang Man, Yang Song-Bin, Yu Wen-Hua, Zhang Zu-Yong
Department of Neurosurgery, The First Hangzhou Municipal People's Hospital, Nanjing Medical University, Hangzhou, China.
J Trauma. 2011 Nov;71(5):1194-8. doi: 10.1097/TA.0b013e31821283f2.
High serum copeptin levels are associated with injury severity after traumatic brain injury (TBI). However, not much is known regarding its relation with mortality. Thus, we sought to evaluate its relation with disease mortality.
Fifty healthy controls and 94 patients with acute severe TBI were included. Plasma samples were obtained on admission and at days 1, 2, 3, 5, and 7. Its concentration was measured by enzyme-linked immunosorbent assay.
Twenty-six patients (27.7%) died from TBI in a month. After brain injury, plasma copeptin level in patients increased during the 6-hour period immediately, peaked in 24 hours, plateaued at day 2, decreased gradually thereafter, and was substantially higher than that in healthy controls during the 7-day period. A forward stepwise logistic regression selected plasma copeptin level (odds ratio, 1.008; 95% confidence interval, 1.002-1.014; p = 0.010) as an independent predictor for 1-month mortality of patients. A multivariate linear regression showed that plasma copeptin level was negatively associated with Glasgow Coma Scale (GCS) score (t = -7.161; p < 0.001). A receiver operating characteristic curve identified plasma copeptin cutoff level (451.8 pg/mL) that predicted 1-month mortality with the optimal sensitivity (88.5%) and specificity (75.0%) values (area under curve, 0.874; 95% confidence interval, 0.789-0.933; p < 0.001). The area under curve of plasma copeptin level was similar to that of GCS score (p = 0.299). However, copeptin did not statistically significantly improve the area under curve of GCS score (p = 0.413).
Increased plasma copeptin levels are associated with mortality after TBI.
血清 copeptin 水平升高与创伤性脑损伤（TBI）后的损伤严重程度相关。然而，关于其与死亡率的关系知之甚少。因此，我们试图评估其与疾病死亡率的关系。
纳入 50 名健康对照者和 94 例急性重度 TBI 患者。在入院时以及第 1、2、3、5 和 7 天采集血浆样本。通过酶联免疫吸附测定法测量其浓度。
26 例患者（27.7%）在一个月内死于 TBI。脑损伤后，患者血浆 copeptin 水平在伤后立即的 6 小时内升高，在 24 小时达到峰值，在第 2 天趋于平稳，此后逐渐下降，并且在 7 天内显著高于健康对照者。向前逐步逻辑回归选择血浆 copeptin 水平（比值比，1.008；95%置信区间，1.002 - 1.014；p = 0.010）作为患者 1 个月死亡率的独立预测因子。多元线性回归显示血浆 copeptin 水平与格拉斯哥昏迷量表（GCS）评分呈负相关（t = -7.161；p < 0.001）。受试者工作特征曲线确定血浆 copeptin 截断水平（451.8 pg/mL），其预测 1 个月死亡率的灵敏度（88.5%）和特异度（75.0%）最佳（曲线下面积，0.874；95%置信区间，0.789 - 0.933；p < 0.001）。血浆 copeptin 水平的曲线下面积与 GCS 评分的曲线下面积相似（p = 0.299）。然而，copeptin 并未在统计学上显著改善 GCS 评分的曲线下面积（p = 0.413）。
血浆 copeptin 水平升高与 TBI 后的死亡率相关。
