Prognostic significance of hypothalamic–pituitary–adrenal axis hormones in early sepsis: a study performed in the emergency department

Abstract

Increased copeptin and HPA hormones baseline levels may provide crucial information for risk stratification in a variety of septic states in the ED. Furthermore, measurements of copeptin level and serum baseline cortisol concentration are promising independent prognostic markers for mortality in patients with severe sepsis or septic shock.

Clinical relevance of copeptin plasma levels as a biomarker of disease severity and mortality in critically ill patients

“…In contrast to our study, a large observational single‐center study from Beijing that included 461 patients admitted to the Emergency Department reported that copeptin levels might serve as an early diagnostic indicator of sepsis . Importantly, this study also noted an association between copeptin and disease severity as well as short‐term mortality in the Emergency Department setting .…”

“…In contrast to our study, a large observational single‐center study from Beijing that included 461 patients admitted to the Emergency Department reported that copeptin levels might serve as an early diagnostic indicator of sepsis . Importantly, this study also noted an association between copeptin and disease severity as well as short‐term mortality in the Emergency Department setting . Our study that focused on critically ill patients at the ICU revealed that not the presence of sepsis, but the severity of critical illness as reflected by organ failure(s) and hemodynamic alterations was the main determinant for elevated copeptin.…”

“…We conducted a large observational study, in which we prospectively enrolled 218 critically ill patients from our medical ICU, to determine the value of copeptin as a biomarker in the intensive care setting. In line with previous reports of patients with acute illnesses, critically ill patients had significantly higher circulating copeptin levels as compared to healthy controls. However, the disease entity (eg sepsis) or metabolic comorbidities that would affect copeptin levels in the chronic setting did not determine copeptin concentrations in critical illness.…”

“…In line with the biological functions of vasopressin, such as water reabsorption, regulating osmolality, vasoconstriction, and central nervous effects, copeptin levels were found elevated in patients with diabetes insipidus, metabolic diseases, chronic kidney diseases, and cardiovascular disorders . In cohorts of patients with acute illnesses, copeptin levels were increased, especially in patients with sepsis, shock, heart failure, and respiratory distress . Some of these studies suggested that elevated copeptin plasma concentrations might indicate an increased short‐term mortality risk .…”

Copeptin Predicts Mortality in Critically Ill Patients

“…[10] Another study evaluating 461 patients admitted to the emergency department of a tertiary university hospital with signs of sepsis, demonstrated predictive abilities of copeptin levels at admission for the occurrence of septic shock and mortality. [18] In a small study evaluating 41 septic patients a strong correlation between copeptin and the disease severity score APACHE II was demonstrated. [19] In our cohort, only weak correlations between copeptin and APACHE II scores, as well as other established scores including the SAPS II and the SOFA score were demonstrated.…”