Koch Alexander, Yagmur Eray, Hoss Alexander, Buendgens Lukas, Herbers Ulf, Weiskirchen Ralf, Koek Ger H, Trautwein Christian, Tacke Frank
Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany.
Medical Care Center, Dr. Stein and Colleagues, Mönchengladbach, Germany.
J Clin Lab Anal. 2018 Nov;32(9):e22614. doi: 10.1002/jcla.22614. Epub 2018 Jul 5.
Copeptin, also termed C-terminal pre-pro-vasopressin or CTproAVP, mirrors endogenous vasopressin (anti-diuretic hormone, ADH) activity and might thereby serve as a biomarker reflecting the biological stress level. We therefore hypothesized that copeptin plasma concentrations are associated with disease severity in critically ill patients and could predict mortality.
We analyzed plasma copeptin levels in a prospective, single-center, observational study comprising 218 critically ill patients at admission to the medical intensive care unit (ICU). Mortality was assessed during a 2-year observational follow-up period.
Copeptin plasma levels were significantly elevated in critically ill patients (n = 218) at ICU admission, as compared with 66 healthy controls. Neither sepsis as the cause of critical illness nor pre-existing metabolic disorders (type 2 diabetes, obesity) were found to influence copeptin levels. On the contrary, plasma copeptin was closely associated with disease severity (eg APACHE-II score) and correlated with biomarkers of inflammation, renal failure, metabolism, vascular tone, and tissue perfusion. Elevated copeptin levels at ICU admission predicted short-term and long-term mortality.
Copeptin plasma concentrations are significantly elevated in critically ill patients, correlate with disease severity and predict ICU and long-term outcome. Thus, copeptin could be a promising tool for prognostication and management of critically ill patients.
copeptin，也称为C末端前体血管加压素或CTproAVP，反映内源性血管加压素（抗利尿激素，ADH）的活性，因此可能作为反映生物应激水平的生物标志物。因此，我们推测危重病患者的copeptin血浆浓度与疾病严重程度相关，并可预测死亡率。
我们在一项前瞻性、单中心、观察性研究中分析了218例入住医学重症监护病房（ICU）的危重病患者入院时的血浆copeptin水平。在2年的观察随访期内评估死亡率。
与66名健康对照者相比，危重病患者（n = 218）在ICU入院时copeptin血浆水平显著升高。未发现作为危重病病因的脓毒症或既往存在的代谢紊乱（2型糖尿病、肥胖）影响copeptin水平。相反，血浆copeptin与疾病严重程度（如APACHE-II评分）密切相关，并与炎症、肾衰竭、代谢、血管张力和组织灌注的生物标志物相关。ICU入院时copeptin水平升高可预测短期和长期死亡率。
危重病患者的copeptin血浆浓度显著升高，与疾病严重程度相关，并可预测ICU和长期预后。因此，copeptin可能是危重病患者预后评估和管理的一个有前景的工具。
