Risk stratification of normotensive pulmonary embolism: prognostic impact of copeptin

Abstract

The prognostic value of copeptin, the C-terminal fragment of the precursor protein of vasopressin which is released upon stress, and hypotension in pulmonary embolism is unknown, especially if combined with biomarkers reflecting different pathophysiological axes such as myocardial injury (highsensitivity troponin T (hsTnT)) and stretch (N-terminal pro-brain natriuretic peptide (NT-proBNP)).We prospectively studied 268 normotensive pulmonary embolism patients included in a single-centre cohort study.Patients with an adverse 30-day outcome (5.6%) had higher copeptin levels than patients with a favourable course (median (interquartile range) 51.8 (21.6-90.8) versus 13.2 (5.9-39.3) pmol·L −1 ; p=0.020). Patients with copeptin levels above the calculated optimal cut-off value of 24 pmol·L −1 had a 5.4-fold increased risk for an adverse outcome (95% CI 1.68-17.58; p=0.005). We developed a strategy for risk stratification based on biomarkers. None of 141 patients (52.6%) with hsTnT <14 pg·mL −1 or NT-proBNP <600 pg·mL −1 had an adverse outcome (low risk). Copeptin ⩾24 pmol·L −1 stratified patients with elevated hsTnT and NT-proBNP as intermediate-low and intermediate-high risk (5.6% and 20.0% adverse outcome, respectively). Compared to the algorithm proposed by the 2014 European Society of Cardiology guideline, more patients were classified as low risk (52.8% versus 17.5%, p<0.001) and more patients in the intermediate-high risk group had an adverse outcome (20.0% versus 11.6%).Copeptin might be helpful for risk stratification of normotensive patients with pulmonary embolism, especially if integrated into a biomarker-based algorithm. @ERSpublications Copeptin may improve risk stratification of normotensive pulmonary embolism by reflecting a new pathophysiological axis http://ow.ly/R9nOV

Prognostic value of copeptin in patients with acute pulmonary thromboembolism

“…Copeptin is produced in response to various stressful conditions. These include coronary syndrome, heart failure, pulmonary hypertension and sepsis as well as acute PE, which was reported recently . Copeptin is kept in the pituitary gland and it is released into circulation upon experiencing life‐threatening stress or hypotension.…”

“…Additionally, copeptin came out as an important diagnostic and prognostic biomarker in various acute cardiovascular diseases . Furthermore, several studies reported that copeptin might be a rather significant prognostic marker in risk stratification of detecting early mortality in patients with acute PE . Nevertheless, there have been no reports on the long‐term mortality effects of copeptin in acute PE cases in the literature until now.…”

Risk stratification of pulmonary embolism: clinical evaluation, biomarkers or both?

“…In the study reported by HELLENKAMP et al [11] the results of the biomarker-based approach compared favourably with those of more traditional approaches combining clinical data and biomarkers. In fact, the positive predictive value (95% confidence interval) for the adverse 30-day outcome of the copeptin-based score, the ESC score and the Bova score were 0.20 (0.12-0.32), 0.12 (0.06-0.20) and 0.11 (0.05-0.24), respectively [11].…”

“…In fact, the positive predictive value (95% confidence interval) for the adverse 30-day outcome of the copeptin-based score, the ESC score and the Bova score were 0.20 (0.12-0.32), 0.12 (0.06-0.20) and 0.11 (0.05-0.24), respectively [11]. Conversely, the three scores obtained high and comparable levels of negative predictive value, but the biomarker-based approach classified a larger proportion of patients as low risk (52%) than the ESC score, (17.5%).…”

“…In this issue of the European Respiratory Journal, HELLENKAMP et al [11] report on a quite different approach. Instead of combining clinical variables or clinical rules with biomarkers and echocardiographic data, which may be both time consuming and difficult to implement in all hospitals, these authors propose a risk-stratification process entirely based on biomarkers (ref).…”