copeptin 在慢性阻塞性肺疾病急性加重和急性心力衰竭中的预后和诊断意义：来自 ACE 2 研究的数据。
Prognostic and diagnostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 study.
机构信息
Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
出版信息
Respir Res. 2017 Nov 3;18(1):184. doi: 10.1186/s12931-017-0665-z.
BACKGROUND
Copeptin is a novel biomarker that predicts mortality in lower respiratory tract infections and heart failure (HF), but the diagnostic value of copeptin in acute dyspnea and the prognostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not clear.
METHOD
We determined copeptin and NT-proBNP concentrations at hospital admission in 314 patients with acute dyspnea who were categorized by diagnosis. Survival was registered after a median follow-up of 816 days, and the prognostic and diagnostic properties of copeptin and NT-proBNP were analyzed in acute HF (n = 143) and AECOPD (n = 84) separately.
RESULTS
The median concentration of copeptin at admission was lower in AECOPD compared to acute HF (8.8 [5.2-19.7] vs. 22.2 [10.2-47.9]) pmol/L, p < 0.001), but NT-proBNP discriminated acute HF from non-HF related dyspnea more accurately than copeptin (ROC-AUC 0.85 [0.81-0.89] vs. 0.71 [0.66-0.77], p < 0.0001). Adjusted for basic risk factors, increased copeptin concentrations predicted mortality in AECOPD (HR per log (ln) unit 1.72 [95% CI 1.21-2.45], p = 0.003) and acute HF (1.61 [1.25-2.09], p < 0.001), whereas NT-proBNP concentrations predicted mortality only in acute HF (1.62 [1.27-2.06], p < 0.001). On top of a basic model copeptin reclassified a significant proportion of patients into a more accurate risk strata in AECOPD (NRI 0.60 [0.19-1.02], p = 0.004) and acute HF (0.39 [0.06-0.71], p = 0.020).
CONCLUSION
Copeptin is a strong prognostic marker in both AECOPD and acute HF, while NT-proBNP concentrations predict mortality only in patients with acute HF. NT-proBNP levels are superior to copeptin levels to diagnose acute HF in patients with acute dyspnea.
背景
copeptin 是一种新型生物标志物，可预测下呼吸道感染和心力衰竭（HF）患者的死亡率，但 copeptin 在急性呼吸困难中的诊断价值以及在慢性阻塞性肺疾病急性加重（AECOPD）中的预后意义尚不清楚。
方法
我们在 314 例急性呼吸困难患者入院时测定了 copeptin 和 NT-proBNP 浓度，并根据诊断进行了分类。中位随访 816 天后登记了生存情况，并分别分析了急性 HF（n=143）和 AECOPD（n=84）中 copeptin 和 NT-proBNP 的预后和诊断性能。
结果
AECOPD 患者入院时的 copeptin 中位数浓度低于急性 HF（8.8 [5.2-19.7] 与 22.2 [10.2-47.9] pmol/L，p<0.001），但 NT-proBNP 比 copeptin 更准确地区分了急性 HF 与非 HF 相关的呼吸困难（ROC-AUC 0.85 [0.81-0.89] 与 0.71 [0.66-0.77]，p<0.0001）。在调整了基本风险因素后，copeptin 浓度升高可预测 AECOPD（每 log（ln）单位的 HR 为 1.72 [95%CI 1.21-2.45]，p=0.003）和急性 HF（1.61 [1.25-2.09]，p<0.001）的死亡率，而 NT-proBNP 浓度仅在急性 HF 中预测死亡率（1.62 [1.27-2.06]，p<0.001）。在基本模型的基础上，copeptin 可将 AECOPD（NRI 0.60 [0.19-1.02]，p=0.004）和急性 HF（0.39 [0.06-0.71]，p=0.020）中的相当一部分患者重新分类为更准确的危险分层。
结论
copeptin 是 AECOPD 和急性 HF 中强有力的预后标志物，而 NT-proBNP 浓度仅在急性 HF 患者中预测死亡率。在急性呼吸困难患者中，NT-proBNP 水平优于 copeptin 水平来诊断急性 HF。
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