Copeptin Levels Do Not Correlate With Cross-Clamping Time in Patients Undergoing Carotid Endarterectomy Under General Anesthesia

Abstract

Copeptin is a sensitive and more stable surrogate marker for arginine vasopressin. In this study, we evaluated copeptin levels in carotid endarterectomy (CEA) patients, perioperatively, to determine whether copeptin levels can be related to carotid artery cross clamping (CC) time and to postoperative neurological outcomes. Copeptin, interleukin 6, C-reactive protein, cortisol, and brain natriuretic peptide were measured preoperatively (T1) and 3 hours postoperatively (T3) as well as intraoperatively (T2). We recruited 77 patients. Values of copeptin rose gradually over the observed times: T1 = 7.9 (6.4-9.6), T2 = 12.6 (9.3-16.8), and T3 = 72.3 (49.1-111.2) pmol/L. There was a significant difference for repeated measurement ( P = .000, P = .000, and P = .000). Duration of carotid artery CC during CEA does not affect postoperative copeptin level (CC ≤ 13 minutes: 106.8 ± 93.6 pmol/L, CC > 13 minutes: 96.7 ± 89.1 pmol/L; P = .634). Preoperative copeptin level was significantly higher in patients with ulcerated plaque morphology. Activation of the stress axis in patients undergoing CEA results in copeptin elevation. Duration of CC during CEA does not affect postoperative copeptin levels.

Pro B-type Natriuretic Peptide and Midregional Proadrenomedullin are Associated with Incident Carotid Stenosis During Long Term Follow-up

“…Copeptin increases in myocardial infarction, 15 and copeptin levels before and during carotid endarterectomy have been suggested as a marker of ulcerated plaque morphology. 16 Cystatin C is an endogenous inhibitor of cathepsins, and elevated levels of this marker have been cross-sectionally associated with the presence of extracranial carotid artery stenosis in the acute stage of noncardioembolic stroke. 17 The primary aim of the present study was to evaluate the above mentioned biomarkers in relation to an established risk marker such as CRP 18 and conventional risk factors for prediction of incident carotid artery stenosis in a large population-based study of middle-aged individuals.…”

Calprotectin: a biomarker for both infant/childhood and adult disease

“…There is accumulating evidence suggesting that the origin of some forms of adult disease may occur during fetal life. The reported changes in copeptin 5,6 and calprotectin 1,4 levels support the "fetal programming" (or "fetal origins of adult disease") hypothesis which implies that alterations in fetal nutrition may result in developmental adaptations that permanently change the physiology and metabolism of the offspring, thereby predisposing individuals to metabolic, endocrine and cardiovascular disorders later in life 7,8 .…”

“…Another biomarker which may predict cardiovascular disease both in adults and in infants is copeptin 5,6 . Copeptin levels increase in cardiovascular diseases (such as ischemic stroke, acute myocardial infarction, heart failure and intracerebral hemorrhage) and traumatic brain injury 5,6 . Copeptin levels also increase in conditions associated with perinatal stress, such as birth acidosis, asphyxia, chorioamnionitis and sepsis 6 .…”

Copeptin for All

“…Unic-Stojanovic et al, in this issue of Angiology, evaluated whether or not copeptin levels are associated with carotid cross-clamping in patients undergoing carotid endarterectomy (CEA). 1 Although copeptin levels increased from baseline to postoperatively in all patients, no association was found between serum copeptin levels and the duration of carotid artery cross-clamping. 1 Copeptin (C-terminal fragment of proarginine vasopressin) is a novel surrogate marker released in equimolar amounts to arginine vasopressin in response to several stressful situations/ conditions, such as trauma, sepsis, lower respiratory tract infections, hemorrhagic, and septic shock.…”

“…1 During carotid cross-clamping, cerebral blood flow is mainly maintained via the contralateral carotid and the vertebral arteries, thus preserving adequate blood supply to the brain.…”