Plasma copeptin for short term risk stratification in acute pulmonary embolism

Abstract

Copeptin (COP) was reported to have prognostic value in various cardiovascular diseases. We hypothesized that COP levels reflect the severity of acute pulmonary embolism (PE) and may be useful in prognostic assessment. Plasma COP concentrations were measured on the Kryptor Compact Plus platform (BRAHMS, Hennigsdorf, Germany). The study included 107 consecutive patients with diagnosed acute PE (47 males, 60 females), with median age of 65 years (range 20-88). High risk PE was diagnosed in 3 patients (2.8 %), intermediate risk in 69 (64.5 %), and low risk PE in 35 (32.7 %) patients. Control group included 64 subjects (25 males, 39 females; median age 52.5 year, range 17-87). Four patients (3.7 %) died during 30-day observation. Complicated clinical course (CCC) was experienced by 10 (9.3 %) patients. COP level was higher in PE patients than in controls [11.55 pmol/L (5.16-87.97), and 19.00 pmol/L (5.51-351.90), respectively, p < 0.0001], and reflected PE severity. COP plasma concentration in low risk PE was 14.67 nmol/L (5.51-59.61) and in intermediate/high risk PE 19.84 mol/L (5.64-351.90) p < 0.05. Median COP levels in nonsurvivors was higher than in survivors, 84.6 (28.48-351.9) pmol/L and 18.68 (5.512-210.1) pmol/L, respectively, p = 0.009. Subjects with CCC presented higher COP levels than patients with benign clinical course 53.1 (17.95-351.9) pmol/L and 18.16 (5.51-210.1) pmol/L, respectively, p = 0.001. Log-transformed plasma COP was the significant predictor of CCC, OR 16.5 95 % CI 23.2-111.9, p < 0.001. AUC-for prediction of CCC using plasma COP was 0.811 (95 % CI 0.676-0.927). The COP cut off value of 17.95 nmol/l had sensitivity of 100 %, specificity 49.5 %, positive predictive value of 16.9 % and negative predictive value of 100 %. We conclude that plasma COP levels can be regarded for promising marker of severity of acute PE and show potential in risk stratification of these patients.

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

“…Validation of the prognostic impact of copeptin in normotensive PE Copeptin as a surrogate marker for AVP was identified as a helpful novel biomarker for rapid rule-out of myocardial infarction [11,12]. Additionally, it has been shown to predict prognosis in acute coronary syndrome [13], chronic heart failure [14,15], pulmonary hypertension [16] and, recently, acute PE [9,17,18]. In heart failure [14,15], copeptin was superior to natriuretic peptides with regard to the prediction of death.…”

Prognostic value of copeptin in patients with acute pulmonary thromboembolism

“…Copeptin is produced in response to various stressful conditions. These include coronary syndrome, heart failure, pulmonary hypertension and sepsis as well as acute PE, which was reported recently . Copeptin is kept in the pituitary gland and it is released into circulation upon experiencing life‐threatening stress or hypotension.…”

“…In a similar study, Wyzgał et al reported a relationship between disease severity and elevated copeptin level, which demonstrated a prognostic potential in PE. It was further reported that patients who died within 30 days after acute PE diagnosis had significantly higher copeptin levels compared those who survived . The researchers determined that copeptin >17.95 pmol/L levels predicted complicated clinical course (CCC) with a specificity of 49.5% and a sensitivity of 100% while the AUC values for the copeptin in predicting CCC was 0.811 (95% CI: 0.676‐0.927).…”

“…Nevertheless, a basic knowledge of the pathophysiology of PE is necessary to fully understand the qualifications of these biomarkers in decision making and management . In acute PE, the most common cause of death is the acute right ventricular failure and there are limited biomarkers available for predicting acute right ventricular failure …”

“…Additionally, copeptin came out as an important diagnostic and prognostic biomarker in various acute cardiovascular diseases . Furthermore, several studies reported that copeptin might be a rather significant prognostic marker in risk stratification of detecting early mortality in patients with acute PE . Nevertheless, there have been no reports on the long‐term mortality effects of copeptin in acute PE cases in the literature until now.…”