Abstract P176: Predicting Preeclampsia Using Copeptin in Women at Low Risk of Disease

Abstract

Preeclampsia annually kills 76,000 mothers and 500,000 babies worldwide often due to delay in diagnosis secondary to the lack ofsimple, early gestation tests. Elevated circulating copeptin (CPP), the pro-segment of vasopressin, is associated with preeclampsia (PreE). We have demonstrated that CPP is robustly predictive of PreE as early as the 6 th week of gestation in all mothers. Development of PreE is increased 3 fold by a history of PreE. Currently, no test robustly predicts PreE in women without a history of PreE. To evaluate if CPP is predictive in this low risk setting when a predictor is most needed, a nested case-control study was performed to evaluate the predictive characteristics of CPP of women with and without a history of PreE. Maternal plasma CPP concentrations throughout gestation were measured by ELISA. Univariate comparisons were performed. Receiver operating characteristic (ROC curves were constructed to determine sensitivity, specificity, positive and negative predictive values for particular cutoffs. Multivariable logistic regression was performed to control for confounding to examine if CPP was significantly predictive of PreE. Apart from a difference in prior history of PreE, no significant demographic or clinical differences were observed between groups. In all trimesters, CPP predicted PreE similarly or better in women with no history of PreE as evidenced by an elevated ROC Area Under the Curve in comparison to values of women with a history of Pre (1 st trimester: 0.96 vs. 0.85; 2 nd trimester: 0.95 vs. 0.94 ; 3 rd trimester: 0.82 vs. 0.67; p<0.05). Despite controlling for significant covariates such as maternal age, BMI, diabetes, chronic hypertension, and twin gestation, logistic modeling demonstrate that trimester specific CPP cutoffs throughout gestation are significantly associated with the development of PreE in women with no history of PreE (all models p< 0.001). Our data clearly support copeptin as an early predictor of preeclampsia in a low risk cohort. The ability to predict PreE in a low risk cohort with CPP is clinically significant as women in whom the diagnosis of preeclampsia is delayed or missed may now receive the appropriate interventions.