Samuelsson Selma, Engerström Lars, Holm Jonas
Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Medicine, Linköping University, Linköping, Sweden.
Department of Cardiothoracic and Vascular Anesthesiology and Intensive Care, Linköping University Hospital, Department of Anesthesia and Intensive Care, Norrköping Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
J Cardiothorac Vasc Anesth. 2025 May;39(5):1197-1204. doi: 10.1053/j.jvca.2025.02.014. Epub 2025 Feb 11.
To investigate copeptin levels during the full perioperative course in open, adult cardiac surgery with cardiopulmonary bypass (CPB).
Prospective cohort study.
A single-center study conducted in a tertiary care hospital.
We included 61 patients undergoing various cardiac surgical procedures. In the final analysis, 57 patients were evaluated. Patients were divided into 2 subgroups based on preoperative copeptin levels, either above or below the reference level of 10 pmol/L.
No intervention.
Copeptin levels were measured at multiple time points preoperatively, perioperatively, and postoperatively. Copeptin levels significantly increased from a preoperative median of 6.6 pmol/L (interquartile range [IQR], 3.9-11.0) to 27 pmol/L (IQR, 15.0-66.0 pmol/L) after sternotomy (p ≤ 0.001). Peak levels occurred 60 minutes after CPB initiation, reaching 286 pmol/L (IQR, 163-446 pmol/L). After this, the copeptin levels did not drop significantly until CPB termination at 179.5 pmol/L (IQR, 136.0-346.0 pmol/L) (p ≤ 0.001). Subsequent decreases were observed upon arrival in the intensive care unit and throughout the postoperative period. However, at 4 days postoperatively, copeptin levels remained significantly higher (11.5 pmol/L; IQR,7.2-19.0 pmol/L; p ≤ 0.001), than preoperative levels.
This study describes copeptin levels during the perioperative course in adult cardiac surgery. The elevated levels during CPB suggest a strong activation of the arginine vasopressin system, with peak levels exceeding those seen in septic shock. This knowledge will enable further targeted clinical studies on copeptin as a prognostic marker in the field of cardiac surgery.
研究在接受体外循环（CPB）的成人开放性心脏手术围手术期全过程中 copeptin 的水平。
前瞻性队列研究。
在一家三级护理医院进行的单中心研究。
我们纳入了 61 例接受各种心脏手术的患者。最终分析时，对 57 例患者进行了评估。根据术前 copeptin 水平高于或低于 10 pmol/L 的参考水平，将患者分为 2 个亚组。
无干预。
在术前、围手术期和术后的多个时间点测量 copeptin 水平。copeptin 水平从术前中位数 6.6 pmol/L（四分位间距[IQR]，3.9 - 11.0）显著升高至胸骨切开术后的 27 pmol/L（IQR，15.0 - 66.0 pmol/L）（p≤0.001）。峰值出现在 CPB 开始后 60 分钟，达到 286 pmol/L（IQR，163 - 446 pmol/L）。在此之后，copeptin 水平直到 CPB 结束时降至 179.5 pmol/L（IQR，136.0 - 346.0 pmol/L）才显著下降（p≤0.001）。随后在进入重症监护病房时及整个术后期间观察到水平下降。然而，术后 4 天，copeptin 水平仍显著高于术前水平（11.5 pmol/L；IQR，7.2 - 19.0 pmol/L；p≤0.001）。
本研究描述了成人心脏手术围手术期过程中 copeptin 的水平。CPB 期间水平升高表明精氨酸加压素系统强烈激活，峰值水平超过脓毒性休克时所见。这一认识将有助于在心脏手术领域进一步开展关于 copeptin 作为预后标志物的针对性临床研究。
