1Medical Intensive Care Unit, Cochin Hospital, APHP, Paris, France. 2Paris Descartes University, Sorbonne Paris Cité, Paris, France. 3Sudden Death Expertise Centre, INSERM U970, Paris Cardiovascular Research Center, Paris, France. 4Emergency Department, Cochin Hospital, APHP, Paris, France. 5Department of Automated Biological Diagnosis, Cochin Hospital, APHP, Paris, France.
Crit Care Med. 2015 Feb;43(2):422-9. doi: 10.1097/CCM.0000000000000716.
The availability of circulating biomarkers that helps to identify early out-of-hospital cardiac arrest survivors who are at increased risk of long-term mortality remains challenging. Our aim was to prospectively study the association between copeptin and 1-year mortality in patients with out-of-hospital cardiac arrest admitted in a tertiary cardiac arrest center.
Retrospective monocenter study.
Tertiary cardiac arrest center in Paris, France.
Copeptin was assessed at admission and day 3. Pre- and intrahospital factors associated with 1-year mortality were analyzed by multivariate Cox proportional analysis.
None.
Two hundred ninety-eight consecutive out-of-hospital cardiac arrest patients (70.3% male; median age, 60.2 yr [49.9-71.4]) were admitted in a tertiary cardiac arrest center in Paris (France). After multivariate analysis, higher admission copeptin was associated with 1-year mortality with a threshold effect (hazard ratio(5th vs 1st quintile) = 1.64; 95% CI, 1.05-2.58; p = 0.03). Day 3 copeptin was associated with 1-year mortality in a dose-dependent manner (hazard ratio(2nd vs 1st quintile) = 1.87; 95% CI, 1.00-3.49; p = 0.05; hazard ratio(3rd vs 1st quintile) = 1.92; 95% CI, 1.02-3.64; p = 0.04; hazard ratio(4th vs 1st quintile) = 2.12; 95% CI, 1.14-3.93; p = 0.02; and hazard ratio(5th vs 1st quintile) = 2.75; 95% CI, 1.47-5.15; p < 0.01; p for trend < 0.01). For both admission and day 3 copeptin, association with 1-year mortality existed for out-of-hospital cardiac arrest of cardiac origin only (p for interaction = 0.05 and < 0.01, respectively). When admission and day 3 copeptin were mutually adjusted, only day 3 copeptin remained associated with 1-year mortality in a dose-dependent manner (p for trend = 0.01).
High levels of copeptin were associated with 1-year mortality independently from prehospital and intrahospital risk factors, especially in out-of-hospital cardiac arrest of cardiac origin. Day 3 copeptin was superior to admission copeptin: this could permit identification of out-of-hospital cardiac arrest survivors at increased risk of mortality and allow for close observation of such patients.
寻找有助于识别发生院外心脏骤停后具有长期高死亡率风险的幸存者的循环生物标志物仍然具有挑战性。我们的目的是前瞻性研究在巴黎一家三级心脏骤停中心接受治疗的院外心脏骤停患者入院时和第 3 天的 copeptin 与 1 年死亡率之间的关联。
回顾性单中心研究。
法国巴黎的三级心脏骤停中心。
入院时和第 3 天评估 copeptin。通过多变量 Cox 比例分析来分析与 1 年死亡率相关的预住院和院内因素。
无。
298 例连续的院外心脏骤停患者（70.3%为男性；中位年龄为 60.2 岁[49.9-71.4]）被收入巴黎（法国）的一家三级心脏骤停中心。多变量分析后，入院时较高的 copeptin 与 1 年死亡率相关，存在阈值效应（第 5 五分位与第 1 五分位的危险比[5th vs 1st quintile] = 1.64；95%CI，1.05-2.58；p = 0.03）。第 3 天的 copeptin 与 1 年死亡率呈剂量依赖性相关（第 2 五分位与第 1 五分位的危险比[2nd vs 1st quintile] = 1.87；95%CI，1.00-3.49；p = 0.05；第 3 五分位与第 1 五分位的危险比[3rd vs 1st quintile] = 1.92；95%CI，1.02-3.64；p = 0.04；第 4 五分位与第 1 五分位的危险比[4th vs 1st quintile] = 2.12；95%CI，1.14-3.93；p = 0.02；第 5 五分位与第 1 五分位的危险比[5th vs 1st quintile] = 2.75；95%CI，1.47-5.15；p < 0.01；p 趋势 < 0.01）。对于入院时和第 3 天的 copeptin，仅与心源性院外心脏骤停相关（p 交互 = 0.05 和 < 0.01）。当调整入院时和第 3 天的 copeptin 时，仅第 3 天的 copeptin 仍然与 1 年死亡率呈剂量依赖性相关（p 趋势 = 0.01）。
高水平的 copeptin 与 1 年死亡率独立于院前和院内危险因素相关，尤其是与心源性院外心脏骤停相关。第 3 天的 copeptin 优于入院时的 copeptin：这可以识别出具有高死亡率风险的院外心脏骤停幸存者，并允许对这些患者进行密切观察。
