title: Plasma copeptin levels before and during exogenous arginine vasopressin infusion in patients with advanced vasodilatory shock.
abstract: BACKGROUND
  Plasma copeptin levels before and during exogenous arginine vasopressin infusion (AVP) were evaluated, and the value of copeptin levels before AVP therapy to predict complications during AVP therapy and outcome in vasodilatory shock patients was determined.
  
  
  METHODS
  This prospective, observational study was nested in a randomized, controlled trial investigating the effects of two AVP doses (0.033 vs. 0.067 IU/min) on the hemodynamic response in patients with advanced vasodilatory shock due to sepsis, systemic inflammatory response syndrome or after cardiac surgery. Clinical data, plasma copeptin levels and adverse events were recorded before, 24 hours after and 48 hours after randomization.
  
  
  RESULTS
  Plasma copeptin levels were elevated before AVP therapy. During AVP, copeptin levels decreased (P<0.001) in both groups (P=0.73). Copeptin levels at randomization predicted the occurrence of ischemic skin lesions (AUC ROC, 0.73; P=0.04), a fall in platelet count (AUC ROC, 0.75; P=0.01) during AVP and intensive care unit mortality (AUC ROC, 0.67; P=0.04). Twenty-five patients (64.1%) exhibited a decrease in copeptin levels. Patients experiencing a decrease in copeptin levels were older (P=0.04), had a higher Sequential Organ Failure Assessment score count before (P=0.03) and during AVP therapy (P=0.04), had a longer intensive care unit stay (P<0.001) and required AVP therapy longer (P=0.008) than patients without a decrease in copeptin levels during AVP.
  
  
  CONCLUSIONS
  Plasma copeptin levels are elevated in patients with advanced vasodilatory shock. During exogenous AVP therapy, copeptin levels decrease, suggesting suppression of the endogenous AVP system.
authors.affiliation: Department of Intensive Care Medicine, Bern University Hospital, Bern, Switzerland. christian-erik.torgersen@insel.ch
authors.forename: C
authors.initials: C
authors.lastname: Torgersen
authors.forename: G
authors.initials: G
authors.lastname: Luckner
authors.forename: N G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: S
authors.initials: S
authors.lastname: Jochberger
authors.forename: C A
authors.initials: CA
authors.lastname: Schmittinger
authors.forename: V
authors.initials: V
authors.lastname: Wenzel
authors.forename: W R
authors.initials: WR
authors.lastname: Hasibeder
authors.forename: W
authors.initials: W
authors.lastname: Grander
authors.forename: M W
authors.initials: MW
authors.lastname: Dünser
mesh_terms: D000368:Aged; D001127:Arginine Vasopressin / Q000008:administration & dosage / Q000627:therapeutic use*; D016638:Critical Illness; D023381:Endpoint Determination; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012769:Shock / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014664:Vasodilation / Q000502:physiology
chemical_list: D006020:Glycopeptides; C048197:copeptins; D001127:Arginine Vasopressin