title: Copeptin and risk stratification in patients with acute dyspnea.
abstract: BACKGROUND
  The identification of patients at highest risk for adverse outcome who are presenting with acute dyspnea to the emergency department remains a challenge. This study investigates the prognostic value of Copeptin, the C-terminal part of the vasopressin prohormone alone and combined to N-terminal pro B-type natriuretic peptide (NT-proBNP) in patients with acute dyspnea.
  
  
  METHODS
  We conducted a prospective, observational cohort study in the emergency department of a university hospital and enrolled 287 patients with acute dyspnea.
  
  
  RESULTS
  Copeptin levels were elevated in non-survivors (n = 29) compared to survivors at 30 days (108 pmol/l, interquartile range (IQR) 37 to 197 pmol/l) vs. 18 pmol/l, IQR 7 to 43 pmol/l; P < 0.0001). The areas under the receiver operating characteristic curve (AUC) to predict 30-day mortality were 0.83 (95% confidence interval (CI) 0.76 to 0.90), 0.76 (95% CI 0.67 to 0.84) and 0.63 (95% CI 0.53 to 0.74) for Copeptin, NT-proBNP and BNP, respectively (Copeptin vs. NTproBNP P = 0.21; Copeptin vs. BNP P = 0.002). When adjusted for common cardiovascular risk factors and NT-proBNP, Copeptin was the strongest independent predictor for short-term mortality in all patients (HR 3.88 (1.94 to 7.77); P < 0.001) and especially in patients with acute decompensated heart failure (ADHF) (HR 5.99 (2.55 to 14.07); P < 0.0001). With the inclusion of Copeptin to the adjusted model including NTproBNP, the net reclassification improvement (NRI) was 0.37 (P < 0.001). An additional 30% of those who experienced events were reclassified as high risk, and an additional 26% without events were reclassified as low risk.
  
  
  CONCLUSIONS
  Copeptin is a new promising prognostic marker for short-term mortality independently and additive to natriuretic peptide levels in patients with acute dyspnea.
authors.affiliation: Department of Cardiology, University Hospital, Petersgraben 4, Basel, 4031, Switzerland. potockim@uhbs.ch
authors.forename: Mihael
authors.initials: M
authors.lastname: Potocki
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.forename: Alexandra
authors.initials: A
authors.lastname: Mueller
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Thenral
authors.initials: T
authors.lastname: Socrates
authors.forename: Nisha
authors.initials: N
authors.lastname: Arenja
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Andreas
authors.initials: A
authors.lastname: Bergmann
authors.forename: Markus
authors.initials: M
authors.lastname: Noveanu
authors.forename: Peter T
authors.initials: PT
authors.lastname: Buser
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004417:Dyspnea / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D010446:Peptide Fragments; C048197:copeptins; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain