Outcome prediction and temperature dependency of MR-proANP and Copeptin in comatose resuscitated patients

Broessner, Gregor; Haßlacher, Julia; Beer, Ronny; Lackner, Peter; Lehner, Georg; Harler, Ulrich; Schiefecker, Alois Josef; Helbok, Raimund; Pfausler, Bettina; Hammerer-Lercher, Angelika; Joannidis, Michael

doi:10.1016/j.resuscitation.2015.01.013

Cited by 13 publications

(11 citation statements)

References 37 publications

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“…Our finding that copeptin was associated with outcome is in agreement with previous studies [13-16, 21, 22]. Studies by Annborn et al [13,16] and Broessner et al [14] indicate better prognostic precision with early measurements of copeptin which could be one reason for copeptin being significantly associated with survival at 24 h only, in our multivariate analysis. Previous studies have indicated a rapid release and clearance of copeptin [23] after circulatory stress, and this may explain why early copeptin levels would be more strongly associated with early mortality.…”

Section: Discussionsupporting

confidence: 93%

“…Also, high copeptin levels are associated with risk of death in patients with cardiovascular failure [10,11] while low levels have been implemented in clinical practice to rule out non-ST-segment acute myocardial infarction [9,12]. Furthermore, copeptin has been suggested as a promising prognostic biomarker after OHCA [13][14][15][16]. It is unknown whether the prognostic capabilities of AVP/copeptin are related to cardiovascular failure alone or if copeptin is merely a marker of disease severity.…”

Section: Introductionmentioning

confidence: 99%

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Copeptin as a marker of outcome after cardiac arrest: a sub-study of the TTM trial

et al. 2020

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Background: Arginine vasopressin has complex actions in critically ill patients, involving vasoregulatory status, plasma volume, and cortisol levels. Copeptin, a surrogate marker for arginine vasopressin, has shown promising prognostic features in small observational studies and is used clinically for early rule out of acute coronary syndrome. The objective of this study was to explore the association between early measurements of copeptin, circulatory status, and short-term survival after out-of-hospital cardiac arrest. Methods: Serial blood samples were collected at 24, 48, and 72 h as part of the target temperature management at 33°C versus 36°C after cardiac arrest trial, an international multicenter randomized trial where unconscious survivors after out-of-hospital cardiac arrest were allocated to an intervention of 33 or 36°C for 24 h. Primary outcome was 30-day survival with secondary endpoints circulatory cause of death and cardiovascular deterioration composite; in addition, we examined the correlation with extended the cardiovascular sequential organ failure assessment (eCvSOFA) score. Results: Six hundred ninety patients were included in the analyses, of whom 203 (30.3%) developed cardiovascular deterioration within 24 h, and 273 (39.6%) died within 30 days. Copeptin measured at 24 h was found to be independently associated with 30-day survival, hazard ratio 1.17 [1.06-1.28], p = 0.001; circulatory cause of death, odds ratio 1.03 [1.01-1.04], p = 0.001; and cardiovascular deterioration composite, odds ratio of 1.05 [1.02-1.08], p < 0.001. Copeptin at 24 h was correlated with eCvSOFA score with rho 0.19 [0.12-0.27], p < 0.001. Conclusion: Copeptin is an independent marker of severity of the post cardiac arrest syndrome, partially related to circulatory failure.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Copeptin as a marker of outcome after cardiac arrest: a sub-study of the TTM trial

et al. 2020

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“…There is to the best of our knowledge only one study evaluating copeptin levels in comatose patients after CPR including 134 patients that could demonstrate an association of elevated copeptin levels and cerebral functional outcome without evaluating mortality as an outcome parameter. [25]…”

Section: Discussionmentioning

confidence: 99%

Copeptin Predicts Mortality in Critically Ill Patients

et al. 2017

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BackgroundCritically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual’s stress level and was associated with outcome in various disease entities. The aim of this study was to analyze whether circulating levels of copeptin at ICU admission are associated with 30-day mortality.MethodsIn this single-center prospective observational study including 225 consecutive patients admitted to a tertiary medical ICU at a university hospital, blood was taken at ICU admission and copeptin levels were measured using a commercially available automated sandwich immunofluorescent assay.ResultsMedian acute physiology and chronic health evaluation II score was 20 and 30-day mortality was 25%. Median copeptin admission levels were significantly higher in non-survivors as compared with survivors (77.6 IQR 30.7–179.3 pmol/L versus 45.6 IQR 19.6–109.6 pmol/L; p = 0.025). Patients with serum levels of copeptin in the third tertile at admission had a 2.4-fold (95% CI 1.2–4.6; p = 0.01) increased mortality risk as compared to patients in the first tertile. When analyzing patients according to cause of admission, copeptin was only predictive of 30-day mortality in patients admitted due to medical causes as opposed to those admitted after cardiac surgery, as medical patients with levels of copeptin in the highest tertile had a 3.3-fold (95% CI 1.66.8, p = 0.002) risk of dying independent from APACHE II score, primary diagnosis, vasopressor use and need for mechanical ventilation.ConclusionCirculating levels of copeptin at ICU admission independently predict 30-day mortality in patients admitted to a medical ICU.

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“…Therefore, there is a close association between the severity of PCAS, the magnitude of the inflammatory response, the severity of organ dysfunction and neurologic outcome, as inferred from small previous studies on inflammatory biomarkers in this clinical setting. Copeptin levels on admission have been associated with death and subsequent organ failure in one study [35], and were predictive for neurological outcome in another [36], when measured within 48 h after ROSC. Circulating procalcitonin were related with the severity of PCAS and predicted neurological outcome accurately already at 12 h from the arrest [33].…”

Section: Discussionmentioning

confidence: 99%

Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest

Rueda

Cediel

García-García

et al. 2019

Ann. Intensive Care

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BackgroundGrowth differentiation factor 15 (GDF-15) is an inflammatory cytokine released in response to tissue injury. It has prognostic value in cardiovascular diseases and other acute and chronic conditions. Here, we explored the value of GDF-15 as an early predictor of neurologic outcome after an out-of-hospital cardiac arrest (OHCA).MethodsProspective registry study of patients in coma after an OHCA, admitted in the intensive cardiac care unit from a single university center. Serum levels of GDF-15 were measured on admission. Neurologic status was evaluated according to the cerebral performance category (CPC) scale. The relationship between GDF-15 levels and poor neurologic outcome at 6 months was analyzed.ResultsAmong 62 patients included, 32 (51.6%) presented poor outcome (CPC 3–5). Patients with CPC 3–5 exhibited significantly higher GDF-15 levels (median, 17.1 [IQR, 11.1–20.4] ng/mL) compared to those with CPC 1–2 (7.6 [IQR, 4.1–13.1] ng/mL; p = 0.004). Multivariable logistic regression analyses showed that age (OR, 1.09; 95% CI 1.01–1.17; p = 0.020), home setting arrest (OR, 8.07; 95% CI 1.61–40.42; p = 0.011), no bystander cardiopulmonary resuscitation (OR, 7.91; 95% CI 1.84–34.01; p = 0.005), and GDF-15 levels (OR, 3.74; 95% CI 1.32–10.60; p = 0.013) were independent predictors of poor outcome. The addition of GDF-15 in a dichotomous manner (≥ 10.8 vs. < 10.8 ng/mL) to the resulting clinical model improved discrimination; it increased the area under the curve from 0.867 to 0.917, and the associated continuous net reclassification improvement was 0.90 (95% CI 0.48–1.44), which allowed reclassification of 37.1% of patients.ConclusionsAfter an OHCA, increased GDF-15 levels were an independent, early predictor of poor neurologic outcome. Furthermore, when added to the most common clinical factors, GDF-15 improved discrimination and allowed patient reclassification.

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Outcome prediction and temperature dependency of MR-proANP and Copeptin in comatose resuscitated patients

Cited by 13 publications

References 37 publications

Copeptin as a marker of outcome after cardiac arrest: a sub-study of the TTM trial

Copeptin as a marker of outcome after cardiac arrest: a sub-study of the TTM trial

Copeptin Predicts Mortality in Critically Ill Patients

Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest

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