title: Increased 90-day mortality in patients with acute heart failure with elevated copeptin: secondary results from the Biomarkers in Acute Heart Failure (BACH) study.
abstract: BACKGROUND
  In patients with heart failure (HF), increased arginine vasopressin concentrations are associated with more severe disease, making arginine vasopressin an attractive target for therapy. However, AVP is difficult to measure due to its in vitro instability and rapid clearance. Copeptin, the C-terminal segment of preprovasopressin, is a stable and reliable surrogate biomarker for serum arginine vasopressin concentrations.
  
  
  RESULTS
  The Biomarkers in Acute Heart Failure (BACH) trial was a 15-center, diagnostic and prognostic study of 1641 patients with acute dyspnea; 557 patients with acute HF were included in this analysis. Copeptin and other biomarker measurements were performed by a core laboratory at the University of Maryland. Patients were followed for up to 90 days after initial evaluation for the primary end point of all-cause mortality, HF-related readmissions, and HF-related emergency department visits. Patients with copeptin concentrations in the highest quartile had increased 90-day mortality (P<0.001; hazard ratio, 3.85). Mortality was significantly increased in patients with elevated copeptin and hyponatremia (P<0.001; hazard ratio, 7.36). Combined end points of mortality, readmissions, and emergency department visits were significantly increased in patients with elevated copeptin. There was no correlation between copeptin and sodium (r=0.047).
  
  
  CONCLUSIONS
  This study showed significantly increased 90-day mortality, readmissions, and emergency department visits in patients with elevated copeptin, especially in those with hyponatremia. Copeptin was highly prognostic for 90-day adverse events in patients with acute HF, adding prognostic value to clinical predictors, ser um sodium, and natriuretic peptides.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00537628.
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: Yang
authors.initials: Y
authors.lastname: Xue
authors.forename: Kevin
authors.initials: K
authors.lastname: Shah
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Richard
authors.initials: R
authors.lastname: Nowak
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Martin
authors.initials: M
authors.lastname: Mockel
authors.forename: Christopher
authors.initials: C
authors.lastname: Hogan
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.forename: Leong
authors.initials: L
authors.lastname: Ng
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.forename: Sean-Xavier
authors.initials: SX
authors.lastname: Neath
authors.forename: Robert
authors.initials: R
authors.lastname: Christenson
authors.forename: Mihael
authors.initials: M
authors.lastname: Potocki
authors.forename: James
authors.initials: J
authors.lastname: McCord
authors.forename: Garret
authors.initials: G
authors.lastname: Terracciano
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kremastinos
authors.forename: Oliver
authors.initials: O
authors.lastname: Hartmann
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
authors.forename: Andreas
authors.initials: A
authors.lastname: Bergmann
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006020:Glycopeptides / Q000097:blood*; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D011379:Prognosis; D012964:Sodium / Q000097:blood; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins; D012964:Sodium