Pozsonyi Zoltán, Förhécz Zsolt, Gombos Tímea, Karádi István, Jánoskuti Lívia, Prohászka Zoltán
3(rd) Department of Internal Medicine, Semmelweis University, Kutvolgyi ut 4, Budapest, H-1114, Hungary.
3(rd) Department of Internal Medicine, Semmelweis University, Kutvolgyi ut 4, Budapest, H-1114, Hungary.
Heart Lung Circ. 2015 Apr;24(4):359-67. doi: 10.1016/j.hlc.2014.10.008. Epub 2014 Nov 13.
The level of copeptin, a stable fragment of pro-arginine-vasopressin (AVP), correlates with disease severity. It is an established, short-term prognostic marker for patients with heart failure with reduced ejection fraction (HFREF). We aimed to examine the association between copeptin and long-term mortality. We also studied the clinical usefulness of copeptin as a prognostic biomarker by analysing the improvement of net reclassification.
Copeptin concentrations were measured in a cohort of 195 consecutive patients with HFREF. Disease severity and clinical parameters were determined at baseline, and all-cause mortality was recorded after five-year follow-up.
One hundred and ten patients died during the five-year follow-up (five-year mortality rate: 0.56). Univariate analysis identified copeptin (HR 2.168 [95% CI 1.740-2.700]) as a predictor of mortality. The final, multivariable Cox survival model identified a number of independent predictors of death. These included higher NHYA functional class, previous MI, at least one hospitalisation for worsening HF (within the two years before inclusion into the study), elevated blood urea nitrogen, NT-proBNP-, and copeptin levels, as well as increased red blood cell distribution width, and decreased GFR. The addition of copeptin alone to the baseline predictive model (NT-proBNP only) resulted in a minor (8.21%) improvement, whereas the final, multivariable model showed a significant increase in net reclassification (10.26%, p=0.015).
These data indicate that copeptin is an independent long-term prognostic marker in HFREF, with possible clinical relevance for multimarker risk prediction algorithms.
copeptin是精氨酸加压素原（AVP）的稳定片段，其水平与疾病严重程度相关。它是射血分数降低的心力衰竭（HFREF）患者已确立的短期预后标志物。我们旨在研究copeptin与长期死亡率之间的关联。我们还通过分析净重新分类的改善情况，研究了copeptin作为预后生物标志物的临床实用性。
对195例连续的HFREF患者队列测定copeptin浓度。在基线时确定疾病严重程度和临床参数，并在五年随访后记录全因死亡率。
在五年随访期间，110例患者死亡（五年死亡率：0.56）。单变量分析确定copeptin（HR 2.168 [95% CI 1.740 - 2.700]）为死亡率的预测因子。最终的多变量Cox生存模型确定了多个死亡的独立预测因子。这些包括更高的NYHA功能分级、既往心肌梗死、至少一次因心力衰竭恶化住院（在纳入研究前两年内）、血尿素氮升高、NT-proBNP和copeptin水平升高，以及红细胞分布宽度增加和肾小球滤过率降低。仅将copeptin添加到基线预测模型（仅NT-proBNP）中导致轻微改善（8.21%），而最终的多变量模型显示净重新分类有显著增加（10.26%，p = 0.015）。
这些数据表明，copeptin是HFREF中独立的长期预后标志物，对多标志物风险预测算法可能具有临床相关性。
