Copeptin is an independent prognostic factor for transplant‐free survival in cirrhosis

Abstract

Serum copeptin concentration increases significantly along with the severity of cirrhosis as defined by the Child-Pugh classification. A high serum copeptin concentration predicts survival, particularly at 6 months, independently of liver-specific scoring systems in a heterogeneous population of hospitalized cirrhotic patients.

Are we still searching for the fifth element of MELD?

“…The most relevant point to come out of this study by Solà et al is the internal (using the bootstrapping technique) and external validation (using 120 patients from the CANONIC study [2] with the same eligibility criteria as the study cohort) of the prognostic value of copeptin, independently of the MELD score and leukocyte count. We observed a similar prognostic value of copeptin in 184 cirrhotic patients, entering age, C-reactive protein (CRP) and MELD as covariables together with copeptin [3], instead of leukocyte count and MELD, as done in the Spanish study [1].…”

“…Before recommending the use of copeptin measurement, together with the MELD score to better categorize the severity of cirrhotic patients, we wish to add some comments. Although the Spanish study enrolled a higher number of patients than our recent study on this topic (n = 184) [3], the sample size (n = 120) of the cohort used for the external validation is quite small and the prognostic value of copeptin deserves to be further validated externally. We suspect that the number of events (death and liver transplantation are not indicated) among the 120 randomly selected patients was low, since only two variables (copeptin and MELD) were entered into the prognostic model.…”

“…We wonder whether prognostic models using CRP would be as well fitted as those built with leukocyte count in the study by Solà [1]. Patients included in this latter cohort study had a complication of liver cirrhosis but did not suffer from acute on chronic liver failure (ACLF), as previously defined [3]. it would be interesting to investigate whether there is an association between copeptin levels and the risk of development of ACLF in patients admitted for acute decompensation of cirrhosis, since ACLF is the most common cause of death in patients with decompensated cirrhosis.…”

Research update for articles published in EJCI in 2014

“…The pathophysiological importance of galectin 3 in cirrhosis is yet unknown. Kerbert et al [74] confirmed increased copeptin in cirrhosis and reported relations to circulatory dysfunction, severity of cirrhosis and to transplant-free survival. Experimental and clinical results from the same group showed that copeptin correlated with MELD and MELD-Na scores indicating a potential benefit of combining copeptin with specific prognostic scores [75].…”

The efficacy of serum copeptin and zinc-alpha2-glycoprotein for predictors of tolvaptan treatment in decompensated cirrhotic patients

“…cardiovascular instability, chronic heart failure, sepsis) disturbances of the vasopressinergic system contribute to disease pathogenesis 3 . Current reports have demonstrated that a high serum copeptin concentration predicts survival in a heterogeneous population of hospitalized liver cirrhosis (LC) patients, independent of liver-speci c scoring systems 4 , suggesting that copeptin has the potential to be a biomarker of disease progression and prognosis in LC 5 .…”