Blood levels of copeptin on admission predict outcomes in out-of-hospital cardiac arrest survivors treated with therapeutic hypothermia.
Crit Care. 2012 Oct 4;16(5):R187
Authors: Ostadal P, Kruger A, Zdrahalova V, Janotka M, Vondrakova D, Neuzil P, Prucha M
ABSTRACT: INTRODUCTION: Prognostic stratification of cardiac arrest survivors (CAS) is essential for the selection of the most appropriate therapeutic strategy. However, accurate early outcome predictions for this patient population remain challenging. At present, there is a lack of data examining the prognostic value of C-terminal provasopressin (copeptin) in CAS. METHODS: A group of 40 out-of-hospital CAS who were treated with endovascular hypothermia were analyzed. Copeptin levels were measured in blood samples taken at admission using a commercially available immunoassay. Neurological outcome was assessed at 30 days post-admission according to Cerebral Performance Category (CPC): CPC1 - no neurological deficit; CPC2 - mild to moderate dysfunction; CPC3 - severe dysfunction; CPC4 - coma; and CPC5 - death. RESULTS: Copeptin levels were significantly lower in patients with CPC1 compared with CPC2 or CPC3-5 (74.3+/-14.4 pmol/L, 219.8+/-33.9 pmol/L and 302.7+/-52.1 pmol/L, respectively; P<0.0001). By using the optimal cutoff value of [less than or equal to]217.9 pmol/L calculated from the receiver operating characteristic (ROC) curve (area under curve 0.801, 95% confidence interval [CI] 0.644 to 0.910, P=0.0001), the sensitivity of predicting survival with good neurological outcome was 78.6%, and the specificity was 75.0%. Multiple logistic regression analysis revealed that a copeptin level >217.9 pmol/L was an independent predictor of severe neurological dysfunction or death, with an adjusted odds ratio of 27.00 (95%CI 2.27 to 321.68; P=0.009). CONCLUSIONS: The present study found that copeptin levels have a significant prognostic value at the time of hospital admission, and are a promising diagnostic tool for predicting outcomes in out-of-hospital CAS.
PMID: 23036303 [PubMed - as supplied by publisher]