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BMC+Med
2014 ; 12
(?): 80
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Risk stratification in emergency patients by copeptin
#MMPMID24884642
Iversen K
; Gøtze JP
; Dalsgaard M
; Nielsen H
; Boesgaard S
; Bay M
; Kirk V
; Nielsen OW
; Køber L
BMC Med
2014[May]; 12
(?): 80
PMID24884642
show ga
BACKGROUND: Rapid risk stratification is a core task in emergency medicine.
Identifying patients at high and low risk shortly after admission could help
clinical decision-making regarding treatment, level of observation, allocation of
resources and post discharge follow-up. The purpose of the present study was to
determine short-, mid- and long-term mortality by plasma measurement of copeptin
in unselected admitted patients. METHOD: Consecutive patients >40-years-old
admitted to an inner-city hospital were included. Within the first 24 hours after
admission, a structured medical interview was conducted and self-reported medical
history was recorded. All patients underwent a clinical examination, an
echocardiographic evaluation and collection of blood for later measurement of
risk markers. RESULTS: Plasma for copeptin measurement was available from 1,320
patients (average age 70.5 years, 59.4% women). Median follow-up time was 11.5
years (range 11.0 to 12.0 years). Copeptin was elevated (that is, above the 97.5
percentile in healthy individuals).Mortality within the first week was 2.7%
(17/627) for patients with elevated copeptin (above the 97.5 percentile, that is,
>11.3 pmol/L) compared to 0.1% (1/693) for patients with normal copeptin
concentrations (that is, ?11.3 pmol/L) (P <0.01). Three-month mortality was 14.5%
(91/627) for patients with elevated copeptin compared to 3.2% (22/693) for
patients with normal copeptin. Similar figures for one-year mortality and for the
entire observation period were 27.6% (173/627) versus 8.7% (60/693) and 82.9%
(520/527) versus 57.5% (398/693) (P <0.01 for both), respectively.Using
multivariable Cox regression analyses shows that elevated copeptin was
significantly and independently related to short-, mid- and long-term mortality.
Adjusted hazard ratios were 2.4 for three-month mortality, 1.9 for one-year
mortality and 1.4 for mortality in the entire observation period. CONCLUSIONS: In
patients admitted to an inner-city hospital, copeptin was strongly associated
with short-, mid- and long-term mortality. The results suggest that rapid
copeptin measurement could be a useful tool for both disposition in an emergency
department and for mid- and long-term risk assessment.
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