Prognostic and diagnostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 study

Respiratory Research

Research

Ståle Nygård¹  Heidi Strand²  Arne Didrik Høiseth³  Torbjørn Omland³  Jacob A. Winther³  Jon Brynildsen³  Ivar Følling³  Helge Røsjø³  Geir Christensen⁴ 

[1] Bioinformatics Core Facility, Institute for Medical Informatics, Oslo University Hospital and University of Oslo, Oslo, Norway;Division of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway;Division of Medicine, Akershus University Hospital, Lørenskog, Norway;Institute of Clinical Medicine, University of Oslo, Oslo, Norway;Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway;

关键词: Copeptin;    NT-proBNP;    COPD;    Heart failure;    Epidemiology;    Dyspnea;    Hyponatremia;    Vasopressin;    Antidiuretic hormone;   

DOI  :  10.1186/s12931-017-0665-z

 received in 2017-05-29, accepted in 2017-10-11,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCopeptin is a novel biomarker that predicts mortality in lower respiratory tract infections and heart failure (HF), but the diagnostic value of copeptin in acute dyspnea and the prognostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not clear.MethodWe determined copeptin and NT-proBNP concentrations at hospital admission in 314 patients with acute dyspnea who were categorized by diagnosis. Survival was registered after a median follow-up of 816 days, and the prognostic and diagnostic properties of copeptin and NT-proBNP were analyzed in acute HF (n = 143) and AECOPD (n = 84) separately.ResultsThe median concentration of copeptin at admission was lower in AECOPD compared to acute HF (8.8 [5.2–19.7] vs. 22.2 [10.2–47.9]) pmol/L, p < 0.001), but NT-proBNP discriminated acute HF from non-HF related dyspnea more accurately than copeptin (ROC-AUC 0.85 [0.81–0.89] vs. 0.71 [0.66–0.77], p < 0.0001). Adjusted for basic risk factors, increased copeptin concentrations predicted mortality in AECOPD (HR per log (ln) unit 1.72 [95% CI 1.21–2.45], p = 0.003) and acute HF (1.61 [1.25–2.09], p < 0.001), whereas NT-proBNP concentrations predicted mortality only in acute HF (1.62 [1.27–2.06], p < 0.001). On top of a basic model copeptin reclassified a significant proportion of patients into a more accurate risk strata in AECOPD (NRI 0.60 [0.19–1.02], p = 0.004) and acute HF (0.39 [0.06–0.71], p = 0.020).ConclusionCopeptin is a strong prognostic marker in both AECOPD and acute HF, while NT-proBNP concentrations predict mortality only in patients with acute HF. NT-proBNP levels are superior to copeptin levels to diagnose acute HF in patients with acute dyspnea.

【 授权许可】

CC BY   
© The Author(s). 2017