Copeptin for risk stratification in acute illness: beyond cardiological problems

Copeptin (Cop) has been recently proposed as a reliable marker for the diagnosis of acute coronary syndrome, altough its concentration was found to increase in a variety of other severe clinical conditions. The aim of the present study was to assess the utility of Cop to identify high-risk patients in the emergency room (ER). Eighty-five patients admitted to ER of the San Maurizio Regional Hospital of Bolzano between February to March 2010 with epigastric or chest pain and/or discomfort were included in the study. Blood was drawn at admission and sampled for Cop in standard laboratory tests. Cop levels were significantly higher in patients who died at the hospital or shortly afterwards as compared with survivors (median 61 vs 40.6 pmol/L; P=0.014). Cop levels were also higher in patients with severe health problems (62.9 vs 28.3 pmol/L; P 33.1 pmol/L correctly identified in-hospital death with 71% sensitivity and 74% specificity. A Cop level >13.6 pmol/L was instead associated with 89% sensitivity and 80% specificity for identifying patients with acute and severe conditions. The results of our analysis would suggest that the use of Cop may be a valuable aid in the ER for identifying patients with life-threatening conditions.

[1]  G. Lippi,et al.  Diagnostic significance of haematological testing in patients presenting at the Emergency Department , 2012 .

[2]  G. Lippi,et al.  Considerations for early acute myocardial infarction rule-out for emergency department chest pain patients: the case of copeptin , 2012, Clinical chemistry and laboratory medicine.

[3]  P. Ponikowski,et al.  Increased 90-Day Mortality in Patients With Acute Heart Failure With Elevated Copeptin: Secondary Results From the Biomarkers in Acute Heart Failure (BACH) Study , 2011, Circulation. Heart failure.

[4]  M. Christ-Crain,et al.  The stress hormone copeptin: a new prognostic biomarker in acute illness. , 2010, Swiss medical weekly.

[5]  S. Blankenberg,et al.  Copeptin improves early diagnosis of acute myocardial infarction. , 2010, Journal of the American College of Cardiology.

[6]  A. Gass,et al.  Copeptin: A novel, independent prognostic marker in patients with ischemic stroke , 2009, Annals of neurology.

[7]  N. Morgenthaler,et al.  Incremental value of copeptin for rapid rule out of acute myocardial infarction. , 2009, Journal of the American College of Cardiology.

[8]  J. Struck,et al.  C-terminal provasopressin (copeptin) is associated with left ventricular dysfunction, remodeling, and clinical heart failure in survivors of myocardial infarction. , 2008, Journal of cardiac failure.

[9]  N. Morgenthaler,et al.  Copeptin, a stable peptide derived from the vasopressin precursor, correlates with the individual stress level. , 2008, Neuro endocrinology letters.

[10]  Jeroen J. Bax,et al.  Universal definition of myocardial infarction. , 2007 .

[11]  J. Struck,et al.  COPEPTIN, A STABLE PEPTIDE OF THE ARGININE VASOPRESSIN PRECURSOR, IS ELEVATED IN HEMORRHAGIC AND SEPTIC SHOCK , 2007, Shock.

[12]  A. Bergmann,et al.  Circulating levels of copeptin, a novel biomarker, in lower respiratory tract infections , 2007, European journal of clinical investigation.

[13]  J. Struck,et al.  Copeptin, a fragment of the vasopressin precursor, as a novel predictor of outcome in heart failure , 2006, European journal of clinical investigation.

[14]  V. Wenzel,et al.  Vasopressin during cardiopulmonary resuscitation: A progress report , 2004, Critical care medicine.

[15]  P. Factor,et al.  Role of vasopressin in the management of septic shock , 2004, Intensive Care Medicine.

[16]  M. Sabatine,et al.  Evaluation of the AccuTnI cardiac troponin I assay for risk assessment in acute coronary syndromes. , 2003, Clinical chemistry.