Background: This study aimed to assess the role of copeptin as a diagnostic marker of heart failure (HF) and outcomes. Method: We randomly recruited 76 cardiac patients aged 1 month to 15 years and 65 control healthy children matched in age and sex. Based on plasma copeptin level, the study population were sub-grouped into quartiles (Q). Results: The mean age of cases and control was 40.52 ±34.35 months and 42.43 ±30.42 months respectively. Median copeptin level was higher among patients 16.80 (16.4) compared to control 8.00 (3.0), P<0.01. Copeptin level was not statistically significantly different in-between patients with different etiologies of HF, P =0.515. Total leukocytic count, platelets, serum sodium, inotropic score, and troponin were significantly correlated with copeptin quartile. Three-fourth of dead children were within the Q4, and 12.5 % were within the first one, P=0.214. Around 76.5% of patients who had multiorgan dysfunction were within the Q4 while 5.9% belonged to Q1, P=0.022. Of those who developed sepsis, 82.6% and 4.3% were located within Q4 and Q1, P<0.01. All patients who required mechanical ventilation were within Q4, P= 0.005. Conclusion: Plasma level of copeptin is elevated in pediatric HF regardless its etiology and can be used as a predictor of poor outcomes.
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