Key result
Adding serum copeptin to TRISS and MGAP models improves trauma mortality prediction to AUC ~0.96.
Why the study?
Multiple trauma requires early prognostication and stratification, and whether serum copeptin levels correlate with mortality risk and enhance existing TRISS and MGAP scores needed evaluation.
Do serum levels of copeptin predict 30-day mortality and intensive care requirement in patients with multiple trauma?
Cohort
No
Do serum levels of copeptin predict 30-day mortality and intensive care requirement in patients with multiple trauma?
Admission serum copeptin levels correlate with clinical severity in multiple trauma and improve the prediction accuracy of preexisting trauma severity scores.
May refine trauma mortality prediction when added to TRISS/MGAP; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: Multiple trauma deserves early prognostication and stratification. Copeptin, a precursor of vasopressin, is produced in response to stress. We examined the association between serum levels of copeptin and mortality risk in patients with multiple trauma. We aimed to also enhance the previously established Trauma-Related Injury Severity Score (TRISS) and Mechanism, GCS, Age, and Arterial Pressure (MGAP) score with the additional consideration of copeptin levels. METHODS: This single-center prospective cohort study enrolled patients who presented to the emergency department with potential major injuries. The serum levels of copeptin were measured, and the correlation to clinical severity in terms of 30-day mortality and requirement of intensive care management was analyzed. By combining copeptin levels with TRISS or MGAP, comparison between performance of the original models with the copeptin-enhanced models was performed via discrimination, calibration, and reclassification analyses. RESULTS: There was a significant increase in copeptin levels in patients who died within 30 days (median 644.4 pg/L, interquartile range [472.5, 785.9]) or were admitted to intensive care units (233.8 pg/L, [105.7, 366.4]), compared with those who survived (37.49 pg/L, [17.88, 77.68]). Adding the natural log of copeptin levels to the established TRISS and MGAP models improved the AUC of TRISS from 0.89 to 0.96, and that of MGAP from 0.82 to 0.95. Both calibrations as measured by Brier's scores and reclassification as measured by net reclassification improvement or integrated discrimination improvement demonstrated significant improvements. A Web-based calculator was built to generate predicted mortality rates of various models for convenient clinical use. CONCLUSION: Admission serum copeptin levels were correlated with clinical severity in multiple trauma. Coupling copeptin with preexisting trauma severity scores improved prediction accuracy. Copeptin shows promise as a novel biomarker for the prediction of trauma outcome. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III.
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Hsein et al. (2022) conducted a cohort in multiple trauma. Serum copeptin levels was evaluated on 30-day mortality and requirement of intensive care management. Adding serum copeptin levels to established TRISS and MGAP models improved the AUC for predicting mortality in multiple trauma patients from 0.89 to 0.96 and 0.82 to 0.95, respectively.
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