Copeptin concentration following cardiac surgery as a prognostic marker of postoperative acute kidney injury: a prospective cohort study

Yamashita, Keigo; Abe, Takeji; Hayata, Yoshihiro; Hirose, Tomoaki; Hiraga, Seigo; Fukuba, Ryohei; Takemura, Junichi; Tonomura, Rei; Yamamoto, Kazuki; Yokoyama, Shinya; Taniguchi, Shigeki

doi:10.21037/jtd-20-2323

Cited by 3 publications

(4 citation statements)

References 36 publications

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“…14 Elevated p-Copeptin has previously been reported to be associated with acute kidney injury. 23 Renal function is sensitive to circulatory failure and some degree of renal failure is frequently seen after cardiac surgery. [35][36][37] Unless coincidental, these findings might partly explain the low incidence of renal dysfunction reported with a metabolic strategy involving glutamate infusions in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…The sample size must be considered as glutamate was associated with a significantly lower incidence of acute kidney injury in the main study, which included patients from all participating centres 14 . Elevated p‐Copeptin has previously been reported to be associated with acute kidney injury 23 . Renal function is sensitive to circulatory failure and some degree of renal failure is frequently seen after cardiac surgery 35–37 .…”

Section: Discussionmentioning

confidence: 99%

“…18 Elevated copeptin levels after cardiac surgery have been shown to predict postoperative acute kidney injury. 23…”

Section: Introductionmentioning

confidence: 99%

“…Plasma‐Copeptin levels increase after cardiac surgery and appear to peak early at weaning from cardiopulmonary bypass or on arrival in ICU 18 . Elevated copeptin levels after cardiac surgery have been shown to predict postoperative acute kidney injury 23 . Decreasing Copeptin levels after insertion of a left ventricular assist device or heart transplant have been associated with improved cardiac function 24 .…”

Section: Introductionmentioning

confidence: 99%

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Glutamate infusion associated with reduced rises of p‐Copeptin after coronary surgery: Substudy of GLUTAMICS II

Svedjeholm

Ferrari

Vánky

et al. 2023

Acta Anaesthesiol Scand

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BackgroundGlutamate plays a key role for post‐ischaemic recovery of myocardial metabolism. According to post hoc analyses of the two GLUTAMICS trials, patients without diabetes benefit from glutamate with less myocardial dysfunction after coronary artery bypass surgery (CABG). Copeptin reflects activation of the Arginine Vasopressin system and is a reliable marker of heart failure but available studies in cardiac surgery are limited. We investigated whether glutamate infusion is associated with reduced postoperative rises of plasma Copeptin (p‐Copeptin) after CABG.MethodsA prespecified randomised double‐blind substudy of GLUTAMICS II. Patients had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0 and underwent CABG ± valve procedure. Intravenous infusion of 0.125 M L‐glutamic acid or saline at 1.65 mL/kg/h was commenced 10–20 min before the release of the aortic cross‐clamp and then continued for another 150 min P‐Copeptin was measured preoperatively and postoperatively on day one (POD1) and day three. The primary endpoint was an increase in p‐Copeptin from the preoperative level to POD1. Postoperative stroke ≤24 h and mortality ≤30 days were safety outcomes.ResultsWe included 181 patients of whom 48% had diabetes. The incidence of postoperative mortality ≤30 days (0% vs. 2.1%; p = .50) and stroke ≤24 h (0% vs. 3.2%; p = .25) did not differ between the glutamate group and controls. P‐Copeptin increased postoperatively with the highest values recorded on POD1 without significant inter‐group differences. Among patients without diabetes, p‐Copeptin did not differ preoperatively but postoperative rise from preoperative level to POD1 was significantly reduced in the glutamate group (73 ± 66 vs. 115 ± 102 pmol/L; p = .02). P‐Copeptin was significantly lower in the Glutamate group on POD1 (p = .02) and POD 3 (p = .02).ConclusionsGlutamate did not reduce rises of p‐Copeptin significantly after moderate to high‐risk CABG. However, glutamate was associated with reduced rises of p‐Copeptin among patients without diabetes. These results agree with previous observations suggesting that glutamate mitigates myocardial dysfunction after CABG in patients without diabetes. Given the exploratory nature of these findings, they need to be confirmed in future studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…18 Elevated copeptin levels after cardiac surgery have been shown to predict postoperative acute kidney injury. 23…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Glutamate infusion associated with reduced rises of p‐Copeptin after coronary surgery: Substudy of GLUTAMICS II

Svedjeholm

Ferrari

Vánky

et al. 2023

Acta Anaesthesiol Scand

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Association of Preoperative Copeptin Levels with Risk of All-Cause Mortality in a Prospective Cohort of Adult Cardiac Surgery Patients

Filipovic,

Huber,

Kobel

et al. 2024

Cells

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We aimed to investigate the association of preoperative copeptin, a new cardiovascular biomarker, with short- and long-term mortality in a cohort of adult patients undergoing cardiac surgery, including its potential as a prognostic marker for clinical outcome. Preoperative blood samples of the Bern Perioperative Biobank, a prospective cohort of adults undergoing cardiac surgery during 2019, were analyzed. The primary and secondary outcome measures were 30-day and 1-year all-cause mortality. Optimal copeptin thresholds were calculated with the Youden Index. Associations of copeptin levels with the two outcomes were examined with multivariable logistic regression models; their discriminatory capacity was assessed with the area under the receiver operating characteristic (AUROC). A total of 519 patients (78.4% male, median age 67 y (IQR: 60–73 y)) were included, with a median preoperative copeptin level of 7.6 pmol/L (IQR: 4.7–13.2 pmol/L). We identified an optimal threshold of 15.9 pmol/l (95%-CI: 7.7 to 46.5 pmol/L) for 30-day mortality and 15.9 pmol/L (95%-CI: 9.0 to 21.3 pmol/L) for 1-year all-cause mortality. Regression models featured an AUROC of 0.79 (95%-CI: 0.56 to 0.95) for adjusted log-transformed preoperative copeptin for 30-day mortality and an AUROC of 0.76 (95%-CI: 0.64 to 0.88) for 1-year mortality. In patients undergoing cardiac surgery, the baseline levels of copeptin emerged as a strong marker for 1-year all-cause death. Preoperative copeptin levels might possibly identify patients at risk for a complicated, long-term postoperative course, and therefore requiring a more rigorous postoperative observation and follow-up.

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Hemodynamic Management with Vasopressin for Cardiovascular Surgery

Kato,

Mathis,

Shimoda

et al. 2024

Medicina

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Background and Objectives: Vasopressin increases blood pressure through aquaporin-2-mediated water retention and is useful for managing hemodynamics after surgery. However, even after decades of study, clear clinical guidelines on doses and ideal use cases after cardiovascular surgery remain unclear. Here, the existing literature is synthesized on vasopressin use for cardiac surgeries and coupled with real-world clinical experience to outline a clearer clinical path for vasopressin use. Materials and Methods: Literature from 1966 to the present was searched, and information on surgical outcomes for cardiovascular surgery was extracted. Clinicians from the University of Tsukuba with extensive vasopressin experience in pediatric cardiovascular patients were consulted for general use guidelines. Results: Vasopressin response after cardiovascular surgery is multifaceted, and low-power trials, plus conflicting study reports, generally render it as a secondary choice behind norepinephrine. Clinical experience indicates that low doses of 0.2–0.3 mU/kg/min with constant blood pressure and oxygen monitoring for response are required. Although sole use is not recommended, vasopressin may aid in controlling hemodynamics when given with other volemic or osmolal drugs. Conclusions: Vasopressin may work in a select population of first-line non-responders, but relevant response factors remain unanalyzed and clear guidelines for use remain unestablished. Future, large-scale studies are needed to delineate temporal and demographic characteristics that affect response to vasopressin for the purpose of managing post-surgical capillary leakage and hemodynamics.

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Copeptin concentration following cardiac surgery as a prognostic marker of postoperative acute kidney injury: a prospective cohort study

Cited by 3 publications

References 36 publications

Glutamate infusion associated with reduced rises of p‐Copeptin after coronary surgery: Substudy of GLUTAMICS II

Glutamate infusion associated with reduced rises of p‐Copeptin after coronary surgery: Substudy of GLUTAMICS II

Association of Preoperative Copeptin Levels with Risk of All-Cause Mortality in a Prospective Cohort of Adult Cardiac Surgery Patients

Hemodynamic Management with Vasopressin for Cardiovascular Surgery

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