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2014, Number 1

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Rev Mex Patol Clin Med Lab 2014; 61 (1)

Copeptin as a predictive biomarker of severity and mortality in intensive care unit patients

Malagamba-Monjarás M, Pla-Casamitjana CF, Noffal-Nuño VM, Alcázar-González GA

Language: Spanish
References: 16
Page: 5-10
PDF size: 467.13 Kb.


ABSTRACT

Context: One of the most representative hormones of physiological stress is arginine vasopressin (AVP). It comes from pre-provasopressin, which contains copeptin within its structure. Because it is produced in equimolar ratio with AVP and is found to be more stable, it can be used as a surrogate marker. APACHE II and SOFA scores are commonly used in the ICU for predicting severity and mortality of patients, so they were used in this study to correlate with copeptin values. Objective: To determine the clinical utility of copeptin as a biomarker for severity and prognosis of morbimortality in critically ill patients. Material and methods: Prospective study with data from patients older than 18 years, on intensive care unit, with copeptin determination and calculation of APACHE II and SOFA. The sample consisted of 37 patients. Two outcomes were established: Improvement and death. For the statistics, Kolmogorov-Smirnov, two-way ANOVA, Spearman test and ROC curves were used. The determination of copeptin was made in a Kryptor equipment. Results: The scatter plots showed better correlation at lower values between copeptin with APACHE and copeptin with SOFA. The Spearman test denoted a low correlation between copeptin and both prognostic scales. In assessing outcomes by two-way ANOVA, copeptin showed increased mortality at higher values with a statistical significance < 0.019. In ROC curves, copeptin had a greater area under the curve (AUC) (0.763) compared with APACHE II and SOFA (.528 y .454, respectively). Discussion: Both scores SOFA and APACHE II showed a weak correlation with copeptin. This may be due to the relatively small sample size included in our study. Despite its relatively poor correlation coefficient, copeptin showed a better performance in predicting death in this study. Nevertheless it is still necessary to perform a study with a larger sample in order to reinforce this statement. Conclusions: In this study, copeptin was better as an independent biomarker than APACHE II and SOFA in the statistical tests. Although the correlation between APACHE II and SOFA to copeptin was weak, the use of the combination of both (predictive scale plus biomarker) can be useful to accurately predict mortality in critically ill patients.


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