title: Endogenous vasopressin and copeptin response in multiple trauma patients.
abstract: Endogenous arginine vasopressin (AVP) levels in multiple trauma patients are unknown. Arginine vasopressin is considered to play an important role in severe hemorrhage. In this prospective study, 87 multiple trauma patients (Injury Severity Score >15) and 50 healthy volunteers were enrolled. On admission to the emergency department (ED), demographic, clinical, and laboratory data were documented, and blood was sampled for determination of AVP (radioimmunosassay) and copeptin, a stable fragment of the AVP precursor (immunoluminometric assay). In patients requiring intensive care unit (ICU) therapy, blood and data sampling were repeated at 4, 6, and 24 h after ED admission. Linear logistic and mixed-effects regression analyses were used for statistical analysis. On ED admission, AVP plasma concentrations (43.2 +/- 84.9 pM) were significantly increased when compared with controls (0.92 +/- 0.44 pM, P < 0.001). Plethysmographic oxygen saturation was the only parameter independently associated with AVP (regression coefficient, -0.126; 95% confidence interval, -0.237 to -0.014; P = 0.03). No correlation was observed between AVP and survival (P = 0.62), hemodynamic variables (systolic arterial pressure, P = 0.24; MAP, P = 0.59; diastolic arterial pressure, P = 0.74; central venous pressure, P = 0.36), or brain trauma (P = 0.46). In ICU patients, AVP decreased during the first 24 h (P < 0.001) and was independently associated with heart rate (P = 0.02) and blood glucose (P = 0.009). Copeptin concentrations were correlated with AVP (r2 = 0.718, P < 0.001). In conclusion, AVP was significantly increased in multiple trauma patients and seems to be an integral part of the neuroendocrine response to severe injury. In ICU patients, AVP decreased to moderately elevated levels within 24 h after ED admission.
authors: Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
authors: Isabella
authors: I
authors: Westermann
authors: Martin W
authors: MW
authors: Dünser
authors: Thorsten
authors: T
authors: Haas
authors: Stefan
authors: S
authors: Jochberger
authors: Günter
authors: G
authors: Luckner
authors: Viktoria D
authors: VD
authors: Mayr
authors: Volker
authors: V
authors: Wenzel
authors: Karl-Heinz
authors: KH
authors: Stadlbauer
authors: Petra
authors: P
authors: Innerhofer
authors: Nils
authors: N
authors: Morgenthaler
authors: Walter R
authors: WR
authors: Hasibeder
authors: Wolfgang G
authors: WG
authors: Voelckel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001127:Arginine Vasopressin / Q000097:blood*; D001794:Blood Pressure; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D007022:Hypotension / Q000097:blood; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood* / Q000503:physiopathology; D011446:Prospective Studies; D012044:Regression Analysis; D013997:Time Factors
chemical_list: D006020:Glycopeptides; C048197:copeptins; D001127:Arginine Vasopressin