Postoperative Vasopressin and Copeptin Levels in Noncardiac Surgery Patients

Abstract

Further information on the endogenous arginine vasopressin (AVP) response in patients with postoperative systemic inflammatory response syndrome (SIRS) and vasodilatory shock would provide more insight into the pathophysiology of SIRS-associated cardiovascular failure and help indicate AVP therapy. Patients after uncomplicated abdominal surgery without SIRS (n = 10), critically ill patients after noncardiac surgery with SIRS (n = 9), and patients with SIRS plus vasodilatory shock (n = 22) were included in this prospective trial. Plasma AVP (radioimmunoassay) and copeptin (immunoluminometric assay) concentrations together with clinical parameters were documented daily during the first 7 days postoperative. The AVP response significantly differed between the three groups. Patients without SIRS had lower AVP concentrations than SIRS patients with (P = 0.001) or without shock (P = 0.003). Patients with SIRS and shock had higher AVP levels than patients with SIRS alone (P < 0.001). Arginine vasopressin decreased over time (P = 0.007) in all groups. At day 28, nonsurvivors had higher AVP levels than did survivors (P < 0.001). In SIRS patients without shock, serum osmolarity was indirectly associated with AVP levels, whereas mean arterial blood pressure and serum osmolarity were associated with AVP in SIRS patients with shock. Arginine vasopressin and copeptin correlated significantly with each other (P < 0.001; r = 0.76). In patients without hemofiltration, copeptin levels predicted 28-day mortality with high sensitivity and specificity. The postoperative AVP response in noncardiac surgery patients seems well maintained. The possibility that AVP plays a contributory role in the failure to restore vascular tone in patients with vasodilatory shock cannot be excluded but seems less important than in septic or postcardiotomy shock.

Copeptin as a diagnostic biomarker for sepsis-related deaths

“…Numerous pathophysiological mechanisms have been postulated as contributing to cardiovascular failure in patients with severe sepsis and septic shock. Vascular tone loss and the subsequent decrease in arterial blood pressure and tissue perfusion were indicated as the result of an altered balance of endogenous vasopressor/vasodilator mediators, qualitative and quantitative downregulation of endogenous vasoconstrictor hormone receptors, and inappropriately low levels of neuroendocrine stress hormones, such as arginine vasopressin (AVP) and cortisol [5,6,12,14,21,27].…”

Copeptin predicts 10-year all-cause mortality in community patients: a 10-year prospective cohort study

“…Several studies have reported associations of copeptin levels with adverse outcomes, namely mortality [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

“…These studies include patients with sepsis [16,17], pneumonia and lower respiratory tract infections [16,18,19], stroke [20,21], acute myocardial infarction and congestive heart failure [22][23][24][25], as well as diabetes type 2 [26], metabolic syndrome [27] and diabetes insipidus [28]. Also in primary care, copeptin was found to predict risk in patients with heart failure [29,30], but there is no comprehensive data assessing the usefulness of serum copeptin levels as a general "risk marker" in a patient sample from primary care contacting general practitioners (GPs) due to acute respiratory tract infections (ARTIs).…”

Vasopressina plasmática em pacientes submetidos à correção de aneurisma de aorta infrarrenal

“…The great advantage is that copeptin is very stable in plasma samples and can be measured by immunoluminometric assay, thus turning it into a useful and indicative surrogate of plasmatic AVP levels, with the additional advantage that its measurement is feasible in daily clinical practice [30,31]. Thus, the copeptin evaluation of time course could bring additional and valuable data to better understanding the role of vasopressin in the pathophysiology of surgical stress response.…”