November 24, 2010Open Access
Copeptin and risk stratification in patients with acute dyspnea
Key Result
Copeptin was a strong independent predictor of 30-day mortality in patients with acute dyspnea (HR 3.88), providing additive prognostic value to NT-proBNP.
Study Design
Type
Cohort (n=287)
Multicenter
No
Structured PICO
Does Copeptin measurement predict 30-day mortality in patients presenting with acute dyspnea?
P
Population
287 unselected patients presenting to the emergency department with a chief complaint of acute dyspnea, mean age 74, 52% male. Exclusion criteria: age younger than 18 years, obvious traumatic cause of dyspnea, and patients on haemodialysis.
I
Intervention
Measurement of Copeptin (C-terminal part of the vasopressin prohormone) at presentation
O
Outcome
30-day all-cause mortalityhard clinical
Copeptin is a strong, independent prognostic marker for 30-day mortality in patients presenting to the emergency department with acute dyspnea, providing additive value to NT-proBNP.
Main Result
Effect estimate: HR 3.88 (95% CI 1.94 to 7.77)
p-value: p=<0.001
Limitations
- Data derived from a single-centre study
- Assessed all-cause mortality rather than specific causes of death
- Diagnostic classification of acute decompensated heart failure was possibly not 100% accurate
Abstract
INTRODUCTION: The identification of patients at highest risk for adverse outcome who are presenting with acute dyspnea to the emergency department remains a challenge. This study investigates the prognostic value of Copeptin, the C-terminal part of the vasopressin prohormone alone and combined to N-terminal pro B-type natriuretic peptide (NT-proBNP) in patients with acute dyspnea. METHODS: We conducted a prospective, observational cohort study in the emergency department of a university hospital and enrolled 287 patients with acute dyspnea. RESULTS: Copeptin levels were elevated in non-survivors (n = 29) compared to survivors at 30 days (108 pmol/l, interquartile range (IQR) 37 to 197 pmol/l) vs. 18 pmol/l, IQR 7 to 43 pmol/l; P < 0.0001). The areas under the receiver operating characteristic curve (AUC) to predict 30-day mortality were 0.83 (95% confidence interval (CI) 0.76 to 0.90), 0.76 (95% CI 0.67 to 0.84) and 0.63 (95% CI 0.53 to 0.74) for Copeptin, NT-proBNP and BNP, respectively (Copeptin vs. NTproBNP P = 0.21; Copeptin vs. BNP P = 0.002). When adjusted for common cardiovascular risk factors and NT-proBNP, Copeptin was the strongest independent predictor for short-term mortality in all patients (HR 3.88 (1.94 to 7.77); P < 0.001) and especially in patients with acute decompensated heart failure (ADHF) (HR 5.99 (2.55 to 14.07); P < 0.0001). With the inclusion of Copeptin to the adjusted model including NTproBNP, the net reclassification improvement (NRI) was 0.37 (P < 0.001). An additional 30% of those who experienced events were reclassified as high risk, and an additional 26% without events were reclassified as low risk. CONCLUSIONS: Copeptin is a new promising prognostic marker for short-term mortality independently and additive to natriuretic peptide levels in patients with acute dyspnea.