Predictive Value of Plasma Copeptin Level in Children with Acute Heart Failure

Abstract

We investigated the ability of copeptin level to predict adverse outcome in pediatric heart failure (HF) and correlated copeptin level with various clinical and echocardiographic data. This cohort study was carried out on forty children with clinical picture of acute HF as the patient group and forty healthy children of matched age and sex as the control group. Echocardiographic examination and plasma copeptin level were performed for all included children at admission. Patients were followed up for 6 months for mortality or readmission. Plasma copeptin level was significantly higher in the patient group (16.2 ± 5) pmol/L compared to the control group (4.1 ± 2.3) pmol/L, P ˂0.001. Moreover, copeptin level was positively correlated with Ross classification, being the highest in patients with class IV (19.6 ± 3.9) pmol/L compared to those with class III (15.2 ± 4) pmol/L and class II (10.4 ± 1.5) pmol/L. Copeptin levels were significantly higher in patients with bad prognosis (21.2 ± 4.1) pmol/L compared to those with good prognosis (14.5 ± 4.1) pmol/L, P ˂0.001. Copeptin level had a significant positive correlation with age, heart rate, respiratory rate, and ROSS classification. On the contrary, copeptin level had a significant negative correlation with left ventricular fraction shortening and diastolic function. Copeptin at cut-off value of ≥ 19.5 pmol/L yielded a sensitivity of 75% and a specificity of 93% to predict adverse outcome in children with HF. Plasma copeptin level has a good prognostic value to predict adverse outcome in pediatric heart failure. Moreover, copeptin correlate well with the severity of pediatric HF.

Elevated Copeptin Levels Are Associated with Heart Failure Severity and Adverse Outcomes in Children with Cardiomyopathy

“…Interestingly contrast to adult studies, copeptin levels were not significantly elevated in children with sepsis and septic shock compared to healthy controls [33,34]. Similar to our observations, Amrousy et al have reported copeptin level as an excellent prognostic value to predict adverse outcomes in pediatric heart failure [26]. However, they did not compare the predictive value of copeptin levels with BNP levels and the echocardiography variables of left ventricular function.…”

“…Pediatric data on copeptin level as a predictor of adverse outcomes are limited to few studies, including arterial hypotension in critically ill children, pulmonary hypertension, ventricular dysfunction with vaso-occlusive crises of sickle cell anemia, and pediatric acute heart failure [25,26,[31][32][33]. Gaheen et al showed that copeptin levels were elevated in children with pulmonary hypertension secondary to congenital heart disease [31].…”

“…Several adult studies in patients with heart failure have shown that copeptin can be a useful prognostic biomarker for acute and chronic heart failure [20][21][22][23]. Elevated copeptin levels have been associated with an increase in disease severity and mortality in critically ill children [24][25][26]. In a single-centered study, copeptin levels were associated with adverse outcomes in children with heart failure encompassing mostly children with congenital heart defects [26].…”

“…Elevated copeptin levels have been associated with an increase in disease severity and mortality in critically ill children [24][25][26]. In a single-centered study, copeptin levels were associated with adverse outcomes in children with heart failure encompassing mostly children with congenital heart defects [26]. We conducted this prospective cohort study to measure copeptin levels in children with cardiomyopathy in different stages of heart failure.…”