Serum Copeptin levels in the emergency department predict major clinical outcomes in adult trauma patients

Abstract

Background: Early prognostication in trauma patients is challenging, but particularly important. We wanted to explore the ability of copeptin, the C-terminal fragment of arginine vasopressin, to identify major trauma, defined as Injury Severity Score (ISS) > 15, in a heterogeneous cohort of trauma patients and to compare its performances with lactate. We also evaluated copeptin performance in predicting other clinical outcomes: mortality, hospital admission, blood transfusion, emergency surgery, and Intensive Care Unit (ICU) admission. Methods: This single center, pragmatic, prospective observational study was conducted at Arcispedale Santa Maria Nuova, a level II trauma center in Reggio Emilia, Italy. Copeptin determination was obtained on Emergency Department (ED) arrival, together with venous lactate. Different outcomes were measured including ISS, Revised Trauma Score (RTS), hospital and ICU admission, blood transfusion, emergency surgery, and mortality. Results: One hundred and twenty five adult trauma patients admitted to the ED between June 2017 and March 2018. Copeptin showed a good ability to identify patients with ISS > 15 (AUC 0.819). Similar good performances were recorded also in predicting other outcomes. Copeptin was significantly superior to lactate in identifying patients with ISS > 15 (P 0.0015), and in predicting hospital admission (P 0.0002) and blood transfusion (P 0.016). Comparable results were observed in a subgroup of patients with RTS 7.84. Conclusions: In a heterogeneous group of trauma patients, a single copeptin determination at the time of ED admission proved to be an accurate biomarker, statistically superior to lactate for the identification of major trauma, hospital admission, and blood transfusion, while no statistical difference was observed for ICU admission and emergency surgery. These results, if confirmed, may support a role for copeptin during early management of trauma patients.

Serum levels of copeptin predict adverse outcomes and improve risk prediction of TRISS and MGAP scores in patients with multiple trauma: A single-center prospective cohort study

“…Another study reported that in patients with multiple traumas requiring ICU admission, both copeptin and AVP exhibited peak levels on ED admission followed by a significant decrease within 24 hours but remained above the detection limit 15 . An elevated copeptin level also indicated the need for transfusion in trauma patients 14,16 . These findings were reproduced in our study, where copeptin performed better than scoring models in predicting severity and mortality.…”

“…15 An elevated copeptin level also indicated the need for transfusion in trauma patients. 14,16 These findings were reproduced in our study, where copeptin performed better than scoring models in predicting severity and mortality.…”

Copeptin and Stress

“…[39,118]. A meta-analysis including 2654 patients from 17 studies has recently confirmed previous findings, demonstrating not only a significant association between increased plasma copeptin levels and TBI, but also copeptin is of prognostic value in predicting brain concussion, progressive hemorrhagic injury, acute traumatic coagulopathy, mortality and poor functional outcomes in patients with TBI (AUC 0.83-0.90) [119].…”

RETRACTED ARTICLE: Review novel insights into the diagnostic and prognostic function of copeptin in daily clinical practice

“…Although the serum copeptin and prolactin concentrations were increased in both febrile seizures and epileptic seizures in contrast with serum neuro-filament light chain, the authors could not confirm them as prognostic biomarkers as neither of them was correlated with recurrent seizures [59]. In a group of 125 mixed trauma patients, copeptin was found as a precise prognostic and diagnostic biomarker over lactate, where it showed more accuracy in hospital admission prediction, blood transfusion, and identification of patients with injury severity score (ISS) > 15 than lactate [60]. More recently, in a meta-analysis including 17 studies and 2654 participants with Traumatic brain injury, the authors suggested that copeptin could be a useful prognostic and diagnostic biomarker for Traumatic brain injury [61].…”