Key result
High preoperative copeptin plasma concentration strongly predicted post cardiac surgery vasodilatation with an area under the curve of 0.86.
Why the study?
Does preoperative copeptin plasma concentration predict post cardiac surgery vasodilatation in patients undergoing elective cardiac surgery?
Observational (n=64)
Does preoperative copeptin plasma concentration predict post cardiac surgery vasodilatation in patients undergoing elective cardiac surgery?
High preoperative copeptin plasma concentration strongly predicts post cardiac surgery vasodilatation, suggesting that preoperative activation of the vasopressin system leads to postoperative depletion and a relative deficit.
Preoperative copeptin may aid risk stratification for post-cardiac surgery vasodilatation; hypothesis-generating for vasopressin-targeted trials.
INTRODUCTION: Post cardiac surgery vasodilatation (PCSV) is possibly related to a vasopressin deficiency that could relate to chronic stimulation of adeno-hypophysis. To assess vasopressin system activation, a perioperative course of copeptin and vasopressin plasma concentrations were studied in consecutive patients operated on for cardiac surgery. METHODS: Sixty-four consecutive patients scheduled for elective cardiac surgery with cardiopulmonary bypass were studied. Hemodynamic, laboratory and clinical data were recorded before and during cardiopulmonary bypass, and at the eighth postoperative hour (H8). At the same time, blood was withdrawn to determine plasma concentrations of arginine vasopressin (AVP, radioimmunoassay) and copeptin (immunoluminometric assay). PCSV was defined as mean arterial blood pressure < 60 mmHg with cardiac index ≥ 2.2 l/min/m², and was treated with norepinephrine to restore mean blood pressure > 60 mmHg. Patients with PCSV were compared with the other patients (controls). Student's t test, Fisher's exact test, or nonparametric tests (Mann-Whitney, Wilcoxon) were used when appropriate. Correlation between AVP and copeptin was evaluated and receiver-operator characteristic analysis assessed the utility of preoperative copeptin to distinguish between controls and PCSV patients. RESULTS: Patients who experienced PCSV had significantly higher copeptin plasma concentration before cardiopulmonary bypass (P < 0.001) but lower AVP concentrations at H8 (P < 0.01) than controls. PCSV patients had preoperative hyponatremia and decreased left ventricle ejection fraction, and experienced more complex surgery (redo). The area under the receiver-operator characteristic curve of preoperative copeptin concentration was 0.86 ± 0.04 (95% confidence interval = 0.78 to 0.94; P < 0.001). The best predictive value for preoperative copeptin plasma concentration was 9.43 pmol/l with a sensitivity of 90% and a specificity of 77%. CONCLUSIONS: High preoperative copeptin plasma concentration is predictive of PSCV and suggests an activation of the AVP system before surgery that may facilitate depletion of endogenous AVP stores and a relative AVP deficit after surgery.
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Colson et al. (2011) conducted an observational in Elective cardiac surgery with cardiopulmonary bypass (n=64). Preoperative copeptin plasma concentration vs. Controls (patients without post cardiac surgery vasodilatation) was evaluated on Prediction of post cardiac surgery vasodilatation (PCSV) (AUC 0.86, 95% CI 0.78-0.94, p=<0.001). High preoperative copeptin plasma concentration strongly predicted post cardiac surgery vasodilatation with an area under the curve of 0.86.
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