Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
J Hepatol. 2016 Nov;65(5):914-920. doi: 10.1016/j.jhep.2016.07.003. Epub 2016 Jul 12.
BACKGROUND & AIMS: Research on vasopressin (AVP) in cirrhosis and its role in the assessment of prognosis has been hindered by the difficulty of measuring AVP levels accurately. Copeptin, a 39-aminoacid glycopeptide, is released from the neurohypophysis together with AVP. Copeptin could have a role as biomarker of prognosis in cirrhosis as it may reflect circulatory dysfunction. The aim of this study is to investigate the role of copeptin as biomarker of disease progression and prognosis in cirrhosis.
This prospective study is divided in 2 study protocols including 321 consecutive patients. Plasma copeptin levels were measured in all patients at study inclusion. Protocol 1: to investigate the relationship of copeptin with kidney and circulatory function (56 patients). Protocol 2: to investigate the relationship between copeptin and prognosis, as assessed by the development of complications of cirrhosis or mortality at 3months (265 patients admitted to hospital for complications of cirrhosis).
Patients with decompensated cirrhosis showed significantly higher plasma copeptin levels compared to those of patients with compensated cirrhosis. Copeptin levels had a significant positive correlation with model for end-satge liver disease (MELD) score, AVP, endogenous vasoconstrictor systems, and kidney function parameters. Patients developing complications of cirrhosis or mortality had significantly higher plasma copeptin levels compared to those of the remaining patients. Plasma copeptin levels were an independent predictive factor of both the development of complications and mortality at 3months. This was confirmed in a validation series of 120 patients.
Copeptin is a novel biomarker of disease progression and prognosis in cirrhosis.
Copeptin is a fragment of the vasopressin precursor, a hormone that is known to be increased in patients with cirrhosis and that plays a role in the development of complications of the disease. Vasopressin is difficult to measure, but copeptin is a more stable molecule and is easier to measure in blood. Solà and Kerbert and colleagues have shown in a series of 361 patients that copeptin is markedly increased in patients with cirrhosis who develop complications during the following 3months, compared to those patients who do not develop complications. Moreover, copeptin correlates with prognosis.
由于准确测量血管加压素（AVP）水平存在困难，因此对肝硬化中 AVP 的研究及其在预后评估中的作用受到了阻碍。 copeptin 是一种 39 个氨基酸的糖肽，与 AVP 一起从神经垂体释放。 copeptin 可能作为肝硬化预后的生物标志物发挥作用，因为它可能反映循环功能障碍。本研究旨在探讨 copeptin 作为肝硬化疾病进展和预后生物标志物的作用。
这项前瞻性研究分为 2 个研究方案，包括 321 例连续患者。所有患者在研究纳入时均测量血浆 copeptin 水平。方案 1：研究 copeptin 与肾脏和循环功能的关系（56 例患者）。方案 2：研究 copeptin 与预后的关系，预后通过肝硬化并发症或 3 个月时死亡率来评估（265 例因肝硬化并发症住院的患者）。
与代偿性肝硬化患者相比，失代偿性肝硬化患者的血浆 copeptin 水平显著升高。 copeptin 水平与终末期肝病模型（MELD）评分、AVP、内源性血管收缩系统和肾功能参数呈显著正相关。发生肝硬化并发症或死亡的患者的血浆 copeptin 水平明显高于其余患者。血浆 copeptin 水平是 3 个月时发生并发症和死亡的独立预测因素。在随后的 120 例验证系列中得到了证实。
copeptin 是肝硬化疾病进展和预后的新型生物标志物。
copeptin 是血管加压素前体的片段，已知血管加压素在肝硬化患者中增加，在疾病并发症的发展中起作用。血管加压素难以测量，但 copeptin 是一种更稳定的分子，在血液中更容易测量。 Solà 和 Kerbert 及其同事在 361 例患者的一系列研究中表明，与未发生并发症的患者相比，在接下来的 3 个月内发生并发症的肝硬化患者的 copeptin 水平明显升高。此外， copeptin 与预后相关。
