Clinic of Cardiology and Pneumology, Heart Centre, University Medical Center Goettingen, Goettingen, Germany.
Dept of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Eur Respir J. 2018 Apr 19;51(4). doi: 10.1183/13993003.02037-2017. Print 2018 Apr.
To externally validate the prognostic impact of copeptin, either alone or integrated in risk stratification models, in pulmonary embolism (PE), we performed a analysis of 843 normotensive PE patients prospectively included in three European cohorts.Within the first 30 days, 21 patients (2.5%, 95% CI 1.5-3.8) had an adverse outcome and 12 (1.4%, 95% CI 0.7-2.5) died due to PE. Patients with copeptin ≥24 pmol·L had a 6.3-fold increased risk for an adverse outcome (95% CI 2.6-15.5, p<0.001) and a 7.6-fold increased risk for PE-related death (95% CI 2.3-25.6, p=0.001). Risk classification according to the 2014 European Society of Cardiology (ESC) guideline algorithm identified 248 intermediate-high-risk patients (29.4%) with 5.6% (95% CI 3.1-9.3) at risk of adverse outcomes. A stepwise biomarker-based risk assessment strategy (based on high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and copeptin) identified 123 intermediate-high-risk patients (14.6%) with 8.9% (95% CI 4.5-15.4) at risk of adverse outcomes. The identification of patients at higher risk was even better when copeptin was measured on top of the 2014 ESC algorithm in intermediate-high-risk patients (adverse outcome OR 11.1, 95% CI 4.6-27.1, p<0.001; and PE-related death OR 13.5, 95% CI 4.2-43.6, p<0.001; highest risk group all other risk groups). This identified 85 patients (10.1%) with 12.9% (95% CI 6.6-22.0) at risk of adverse outcomes and 8.2% (95% CI 3.4-16.2) at risk of PE-related deaths.Copeptin improves risk stratification of normotensive PE patients, especially when identifying patients with an increased risk of an adverse outcome.
为了对外验证 copeptin 在预测肺动脉栓塞（PE）中的预后影响，无论是单独使用还是整合到风险分层模型中，我们对前瞻性纳入的三个欧洲队列的 843 例血压正常的 PE 患者进行了分析。在最初的 30 天内，21 例（2.5%，95%CI1.5-3.8）患者出现不良结局，12 例（1.4%，95%CI0.7-2.5）死于 PE。copeptin≥24 pmol·L 的患者发生不良结局的风险增加 6.3 倍（95%CI2.6-15.5，p<0.001），PE 相关死亡的风险增加 7.6 倍（95%CI2.3-25.6，p=0.001）。根据 2014 年欧洲心脏病学会（ESC）指南算法进行的风险分类，确定了 248 例中高危患者（29.4%），其中 5.6%（95%CI3.1-9.3）存在不良结局风险。基于高敏肌钙蛋白 T、N 末端脑钠肽前体和 copeptin 的逐步生物标志物风险评估策略确定了 123 例中高危患者（14.6%），其中 8.9%（95%CI4.5-15.4）存在不良结局风险。当在中高危患者中测量 copeptin 时，甚至可以更好地识别更高风险的患者（不良结局的优势比 11.1，95%CI4.6-27.1，p<0.001；PE 相关死亡的优势比 13.5，95%CI4.2-43.6，p<0.001；最高风险组与所有其他风险组相比）。这确定了 85 例（10.1%）患者，其中 12.9%（95%CI6.6-22.0）存在不良结局风险，8.2%（95%CI3.4-16.2）存在 PE 相关死亡风险。copeptin 改善了血压正常的 PE 患者的风险分层，尤其是在识别不良结局风险增加的患者时。
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