Krychtiuk Konstantin A, Honeder Maria C, Lenz Max, Maurer Gerald, Wojta Johann, Heinz Gottfried, Huber Kurt, Speidl Walter S
Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.
PLoS One. 2017 Jan 24;12(1):e0170436. doi: 10.1371/journal.pone.0170436. eCollection 2017.
Critically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual's stress level and was associated with outcome in various disease entities. The aim of this study was to analyze whether circulating levels of copeptin at ICU admission are associated with 30-day mortality.
In this single-center prospective observational study including 225 consecutive patients admitted to a tertiary medical ICU at a university hospital, blood was taken at ICU admission and copeptin levels were measured using a commercially available automated sandwich immunofluorescent assay.
Median acute physiology and chronic health evaluation II score was 20 and 30-day mortality was 25%. Median copeptin admission levels were significantly higher in non-survivors as compared with survivors (77.6 IQR 30.7-179.3 pmol/L versus 45.6 IQR 19.6-109.6 pmol/L; p = 0.025). Patients with serum levels of copeptin in the third tertile at admission had a 2.4-fold (95% CI 1.2-4.6; p = 0.01) increased mortality risk as compared to patients in the first tertile. When analyzing patients according to cause of admission, copeptin was only predictive of 30-day mortality in patients admitted due to medical causes as opposed to those admitted after cardiac surgery, as medical patients with levels of copeptin in the highest tertile had a 3.3-fold (95% CI 1.66.8, p = 0.002) risk of dying independent from APACHE II score, primary diagnosis, vasopressor use and need for mechanical ventilation.
Circulating levels of copeptin at ICU admission independently predict 30-day mortality in patients admitted to a medical ICU.
入住医疗重症监护病房的重症患者，无论入院原因如何，死亡率都很高。除了在体液和电解质平衡中的作用外，血管加压素还被描述为一种应激激素。 copeptin是血管加压素原的C末端部分，反映血管加压素水平，被认为是个体应激水平的可靠生物标志物，并与各种疾病实体的预后相关。本研究的目的是分析ICU入院时copeptin的循环水平是否与30天死亡率相关。
在这项单中心前瞻性观察研究中，纳入了一家大学医院三级医疗ICU连续收治的225例患者，在ICU入院时采集血液，使用市售的自动化夹心免疫荧光测定法测量copeptin水平。
急性生理与慢性健康状况评分II中位数为20，30天死亡率为25%。与幸存者相比，非幸存者入院时copeptin的中位数水平显著更高（77.6，四分位间距30.7 - 179.3 pmol/L，而幸存者为45.6，四分位间距19.6 - 109.6 pmol/L；p = 0.025）。入院时血清copeptin水平处于第三个三分位数的患者与处于第一个三分位数的患者相比，死亡风险增加了2.4倍（95%可信区间1.2 - 4.6；p = 0.01）。根据入院原因分析患者时，copeptin仅能预测因内科原因入院患者的30天死亡率，与心脏手术后入院的患者不同，因为copeptin水平处于最高三分位数的内科患者死亡风险为3.3倍（95%可信区间1.6 - 6.8，p = 0.002），且与急性生理与慢性健康状况评分II、主要诊断、血管活性药物使用及机械通气需求无关。
ICU入院时copeptin的循环水平可独立预测入住医疗ICU患者的30天死亡率。
