Characterizing vasopressin and other vasoactive mediators released during resuscitation of trauma patients

Cohn, Stephen M.; DeRosa, Mark; McCarthy, Janet; Song, Juquan; White, Christopher E.; Louden, Christopher; Ehler, Benjamin; Michalek, Joel E.; Landry, Donald W.

doi:10.1097/ta.0b013e31829eff31

Cited by 16 publications

(22 citation statements)

References 34 publications

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“…AVP and copeptin levels proved to be clearly correlated in trauma patients, confirming once more the role of copeptin as a surrogate marker for AVP [15]. Moreover, in a cohort of patients with severe trauma, AVP levels were significantly higher in patients with ISS > 15 compared to those with ISS < 15 [23]. Interestingly AVP did not show any correlation with SBP in patients with trauma, suggesting that, in trauma patients, a drop in SBP may not be the only trigger to AVP release, and/or that AVP secretion may be highly effective in sustaining hemodynamic stability, at least in a first compensated phase [16].…”

Section: Discussionsupporting

confidence: 54%

“…Its use in hemorrhagic shock was associated with increased survival in animal studies and in several case reports on humans [35,36]. Although the studies on the relationships between AVP, hypoxia and hypoperfusion are at their early stages, it is intriguing to consider that an early responsiveness of AVP to hypoperfusion (in addition to the other wellknown AVP-triggering stimuli) would explain both the stronger correlation of copeptin with the need for transfusion than with hemodynamic parameters reported in previous studies, and its high reliability, even higher than that of lactate, in predicting the clinical course of patient lacking overt initial physiologic derangement that we observed [23]. It is fascinating to speculate that in the challenging situation of early management of trauma patients copeptin may support the clinician in identifying occult hemorrhage before a drop in SBP or in hemoglobin level.…”

Section: Discussionmentioning

confidence: 73%

“…Interestingly AVP did not show any correlation with SBP in patients with trauma, suggesting that, in trauma patients, a drop in SBP may not be the only trigger to AVP release, and/or that AVP secretion may be highly effective in sustaining hemodynamic stability, at least in a first compensated phase [16]. Conversely, in that same study, copeptin and AVP levels were good predictors for the need of transfusions [23]. This was confirmed in another study of severely injured patients with trauma-related hemorrhagic shock, where copeptin showed the best predictive value compared to AVP and lactate (AUC 0.87 vs 0.81 vs 0.79) [16].…”

Section: Discussionmentioning

confidence: 76%

“…Neuroendocrine response to multiple trauma is complex and far to be completely understood. Only few studies in the literature assessed AVP and/or copeptin in trauma patients [15,16,23]. Increased levels can be detected as early as 20 min after trauma, probably even earlier [23].…”

Section: Discussionmentioning

confidence: 99%

“…Only few studies in the literature assessed AVP and/or copeptin in trauma patients [15,16,23]. Increased levels can be detected as early as 20 min after trauma, probably even earlier [23]. AVP and copeptin levels proved to be clearly correlated in trauma patients, confirming once more the role of copeptin as a surrogate marker for AVP [15].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock

et al. 2019

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IMPORTANCE Current therapies for traumatic blood loss focus on hemorrhage control and blood volume replacement. Severe hemorrhagic shock, however, is associated with a state of arginine vasopressin (AVP) deficiency, and supplementation of this hormone may decrease the need for blood products in resuscitation.OBJECTIVE To determine whether low-dose supplementation of AVP in patients with trauma (hereinafter referred to as trauma patients) and with hemorrhagic shock decreases their need for transfused blood products during resuscitation. DESIGN, SETTING, AND PARTICIPANTSThis randomized, double-blind placebo-controlled clinical trial included adult trauma patients (aged 18-65 years) who received at least 6 U of any blood product within 12 hours of injury at a single urban level 1 trauma center from May 1, 2013, through May 31, 2017. Exclusion criteria consisted of prehospital cardiopulmonary resuscitation, emergency department thoracotomy, corticosteroid use, chronic renal insufficiency, coronary artery disease, traumatic brain injury requiring any neurosurgical intervention, pregnancy, prisoner status, or AVP administration before enrollment. Data were analyzed from May 1, 2013, through May 31, 2017, using intention to treat and per protocol.INTERVENTIONS After administration of an AVP bolus (4 U) or placebo, participants received AVP (Յ0.04 U/min) or placebo for 48 hours to maintain a mean arterial blood pressure of at least 65 mm Hg.MAIN OUTCOMES The primary outcome was total volume of blood product transfused. Secondary end points included total volume of crystalloid transfused, vasopressor requirements, secondary complications, and 30-day mortality.RESULTS One hundred patients underwent randomization (49 to the AVP group and 51 to the placebo group). Patients were primarily young (median age, 27 years [interquartile range {IQR}, 22-25 years]) and male (n = 93) with penetrating trauma (n = 79). Cohort characteristics before randomization were well balanced. At 48 hours, patients who received AVP required significantly less blood products (median, 1.4 [IQR, 0.5-2.6] vs 2.9 [IQR, 1.1-4.8] L; P = .01) but did not differ in requirements for crystalloids (median, 9.9 [IQR, 7.9-13.0] vs 11.0 [8.9-15.0] L; P = .22) or vasopressors (median, 400 [IQR, vs 1400 [IQR, equivalent units; P = .22). Although the groups had similar rates of mortality (6 of 49 [12%] vs 6 of 51 [12%]; P = .94) and total complications (24 of 44 [55%] vs 30 of 47 [64%]; P = .37), the AVP group had less deep venous thrombosis (5 of 44 [11%] vs 16 of 47 [34%]; P = .02).CONCLUSIONS AND RELEVANCE Low-dose AVP during the resuscitation of trauma patients in hemorrhagic shock decreases blood product requirements. Additional research is necessary to determine whether including AVP improves morbidity or mortality.

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Modern resuscitation of hemorrhagic shock: what is on the horizon?

Martin

Schreiber

2014

Eur J Trauma Emerg Surg

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Many different trials are currently underway to discriminate ways to improve outcomes in the severely injured and bleeding patient. This paper will review: (1) recent advances in our understanding of the effects hemorrhagic shock has on the coagulation cascade and vascular endothelium, (2) recent research findings that have changed resuscitation, and (3) resuscitation strategies that are not widely used but under active investigation.

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Characterizing vasopressin and other vasoactive mediators released during resuscitation of trauma patients

Abstract: Prognostic/epidemiologic study, level III.

Cited by 16 publications

References 34 publications

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

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

Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock

Modern resuscitation of hemorrhagic shock: what is on the horizon?

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