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Submitted on December 29, 2005
Accepted on August 23, 2006
Department of Anesthesiology, Innsbruck Medical University, Austria; Department of Research, B.R.A.H.M.S. Aktiengesellschaft, Hennigsdorf, Germany; Institute of Medical Biostatistics, Innsbruck Medical University, Austria; ,Division of Experimental Pathophysiology and Immunology, Biocenter, Innsbruck Medical University, Austria; Department of Anesthesiology and Critical Care Medicine, Krankenhaus der Barmherzigen Schwestern, Ried im Innkreis, Austria; Department of Intensive Care Medicine, University Hospital of Bern, Switzerland
* To whom correspondence should be addressed. E-mail: Stefan.Jochberger{at}uibk.ac.at.
Context: Determination of arginine vasopressin (AVP) concentrations may be helpful to guide therapy in critically ill patients. A new assay analyzing copeptin, a stable peptide derived from the AVP precursor, has been introduced.
Objective: Determination of plasma copeptin concentrations.
Design: Post-hoc analysis of plasma samples and data from a prospective study.
Setting: Twelve-bed general and surgical intensive care unit (ICU) in a tertiary university teaching hospital.
Patients: Seventy healthy volunteers and 157 ICU patients with sepsis, SIRS, and after cardiac surgery.
Interventions: None.
Main Outcome Measures: Copeptin plasma concentrations 24 h after ICU admission. Demographic data, AVP plasma concentrations, and a multiple organ dysfunction syndrome score were documented at the same time.
Results: AVP (P < 0.001) and copeptin (P < 0.001) concentrations were significantly higher in ICU patients than in controls. Patients after cardiac surgery had higher AVP (P = 0.003) and copeptin (P = 0.003) concentrations than patients with sepsis or SIRS. Independent of critical illness, copeptin and AVP correlated highly significantly with each other. Critically ill patients with sepsis and SIRS exhibited a significantly higher ratio of copeptin/AVP plasma concentrations than patients after cardiac surgery (P = 0.012). The American Society of Anesthesiologists' classification (P = 0.046) and C-reactive protein concentrations (P = 0.006) were significantly correlated with the copeptin/AVP ratio.
Conclusions: Plasma concentrations of copeptin and AVP in healthy volunteers and critically ill patients correlate significantly with each other. The ratio of copeptin/AVP plasma concentrations is increased in patients with sepsis and SIRS, suggesting that copeptin may overestimate AVP plasma concentrations in these patients.
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