Copeptin and Peroxiredoxin-4 Independently Predict Mortality in Patients With Nonspecific Complaints Presenting to the Emergency Department

Abstract

Objectives: Patients presenting to emergency departments (ED) with nonspecific complaints (NSCs) such as ''not feeling well,'' ''feeling weak,'' ''being tired,'' ''general deterioration,'' or other similar chief complaints that do not have a readily identifiable probable etiology are a common patient group at risk for adverse outcomes. Certain biomarkers, which have not yet been tested for prognostic value when applied to ED patients with NSCs, have emerged as useful tools for predicting prognosis in patients with a variety of diseases. This study tested the hypothesis that two of these novel markers, copeptin (a C-terminal portion of provasopressin) and ⁄ or peroxiredoxin-4 (Prx4), an enzyme that degrades hydrogen peroxide, singly or together are helpful in predicting death in the near term among patients presenting to the ED with NSCs.Methods: The Basel Non-specific Complaints (BANC) study is a delayed type cross-sectional diagnostic study with a prospective 30-day follow-up. ED patients with NSCs were consecutively enrolled. Patients with vital parameters out of the normal range were excluded. The primary endpoint of this study was the predictive value of copeptin and Prx4 for 30-day mortality in patients with NSCs. Measurement of both copeptin and Prx4 was performed in serum samples with sandwich immunoluminometric assays. Conclusions: Copeptin and Prx4 are new prognostic markers in patients presenting to the ED with NSCs. Copeptin and Prx4 might be valuable tools for risk stratification and decision-making in this patient group.

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

“…In the future, genetic or tissue biomarkers might assist clinicians in distinguishing the frail elderly phenotype from the acutely ill but otherwise healthy geriatric adult with adequate physiologic reserve. [100][101][102][103] In addition, assessing disease-specific prognostic risk (the heart failure prognostic instruments, 22 for example) in conjunction with tools like the ISAR or TRST might yield more accurate estimates of risk for short-term adverse outcomes. Second, in many patients a return to the ED or subsequent hospitalization can be expected and appropriate, but most studies did not distinguish anticipated from unexpected readmissions.…”

New vasoactive peptides in cirrhosis: organ extraction and relation to the vasodilatory state

“…Table 5 Regional levels of CPT, proADM and proANP in 54 patients with cirrhosis, stratified by disease modalities and pharmacologic treatment Table 5 Continued prolonged affection of the heart function without causing acute stress. Copeptin has previously been suggested as a prognostic marker for severity of various diseases [8,28] and survival in cardiac failure and patients presenting, for example, to the emergency department [7,37]. It has been emphasized that the nonspecific character of CPT improves its diagnostic value as a marker of disease processes in multiorgan diseases [38].…”

Plasma copeptin as a predictor of intoxication severity and delayed neurological sequelae in acute carbon monoxide poisoning

“…For example, copeptin levels are independent predictors of survival in critically ill patients suffering from hemorrhagic and septic shock [10]. Furthermore, copeptin levels have prognostic implications in patients with acute myocardial infarction [9], acute heart failure [18], acute exacerbation of chronic obstructive pulmonary disease [19], and in patients with nonspecific complaints [13]. Moreover, several studies suggest prognostic value of plasma copeptin in demonstrating acute neuronal injury in many conditions, such as ischemic stroke [7], intracerebral hemorrhage [23], aneurismal subarachnoid hemorrhage [24], traumatic brain injury [3], and transient ischemic attacks [8].…”