Battista Stefania, Audisio Umberto, Galluzzo Claudia, Maggiorotto Matteo, Masoero Monica, Forno Daniela, Pizzolato Elisa, Ulla Marco, Lucchiari Manuela, Vitale Annarita, Moiraghi Corrado, Lupia Enrico, Settanni Fabio, Mengozzi Giulio
Emergency Medicine Department, "Città della Salute e della Scienza" University Hospital of Turin, Corso Bramante 88, 10126 Turin, Italy.
Clinical Biochemistry Laboratory, "Città della Salute e della Scienza" University Hospital of Turin, Corso Bramante 88, 10126 Turin, Italy.
Biomed Res Int. 2016;2016:3624730. doi: 10.1155/2016/3624730. Epub 2016 Jun 6.
The diagnostic and prognostic usefulness of copeptin were evaluated in septic patients, as compared to procalcitonin assessment. In this single centre and observational study 105 patients were enrolled: 24 with sepsis, 25 with severe sepsis, 15 with septic shock, and 41 controls, divided in two subgroups (15 patients with gastrointestinal bleeding and 26 with suspected SIRS secondary to trauma, acute coronary syndrome, and pulmonary embolism). Biomarkers were determined at the first medical evaluation and thereafter 24, 48, and 72 hours after admission. Definitive diagnosis and in-hospital survival rates at 30 days were obtained through analysis of medical records. At entry, copeptin proved to be able to distinguish cases from controls and also sepsis group from septic shock group, while procalcitonin could distinguish also severe sepsis from septic shock group. Areas under the ROC curve for copeptin and procalcitonin were 0.845 and 0.861, respectively. Noteworthy, patients with copeptin concentrations higher than the threshold value (23.2 pmol/L), calculated from the ROC curve, at admission presented higher 30-day mortality. No significant differences were found in copeptin temporal profile among different subgroups. Copeptin showed promising diagnostic and prognostic role in the management of sepsis, together with its possible role in monitoring the response to treatment.
与降钙素原评估相比，在脓毒症患者中评估了 copeptin 的诊断和预后价值。在这项单中心观察性研究中，共纳入 105 例患者：24 例脓毒症患者、25 例严重脓毒症患者、15 例脓毒性休克患者以及 41 例对照，对照组又分为两个亚组（15 例胃肠道出血患者和 26 例疑似继发于创伤、急性冠状动脉综合征和肺栓塞的全身炎症反应综合征患者）。在首次医学评估时以及入院后 24、48 和 72 小时测定生物标志物。通过分析病历获得 30 天的确诊诊断和院内生存率。入院时，copeptin 能够区分病例与对照，也能区分脓毒症组与脓毒性休克组，而降钙素原也能区分严重脓毒症组与脓毒性休克组。copeptin 和降钙素原的 ROC 曲线下面积分别为 0.845 和 0.861。值得注意的是，入院时 copeptin 浓度高于根据 ROC 曲线计算出的阈值（23.2 pmol/L）的患者 30 天死亡率更高。不同亚组之间 copeptin 的时间变化曲线无显著差异。copeptin 在脓毒症的管理中显示出有前景的诊断和预后作用，以及其在监测治疗反应方面的可能作用。
