title: Usefulness of pre-operative copeptin concentrations to predict post-operative outcome after major vascular surgery.
abstract: The aim of this study was to investigate whether preoperative determination of plasma copeptin levels in addition to plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) could help improve risk stratification in patients who undergo major vascular surgery. One hundred ninety-eight consecutive patients who underwent major vascular surgery (58.6% infrainguinal aortic reconstruction, 23.7% abdominal aortic aneurysm surgery, 17.7% carotid endarterectomy) were included in this study. Patients were monitored for in-hospital and long-term (2-years) major adverse cardiac events, consisting of cardiac death, nonfatal myocardial infarction, and emergent coronary revascularization. Overall, 40 patients (20.2%) reached the primary end point, and most of these events occurred during the index hospital stay (n = 18 [45%]). In univariate Cox regression analysis, increasing concentrations of copeptin were significant determinants of outcome as a continuous variable (hazard ratio [HR] 1.012, p = 0.005) and as a dichotomized variable according to the recommended cutoff of 14.0 pmol/L (HR 4.116, p <0.001). Subgroup analyses revealed that especially patients at low estimated risk according to plasma NT-pro-BNP levels were at significantly higher risk for worse outcomes with higher copeptin levels (HR 5.983, p = 0.002). In multivariate Cox regression analysis, copeptin concentrations >14 pmol/L were significant independent predictors of outcome (HR 2.842, p = 0.002) in addition to type of surgery, history of myocardial infarction, elevated levels of cardiac troponin T, and NT-pro-BNP levels. In conclusion, the results of this study suggest that preoperative determination of this new biomarker could substantially improve prediction of perioperative and postoperative outcomes in vascular surgery patients.
authors.affiliation: 3rd Department of Medicine, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Jarai
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mahla
authors.forename: Thomas
authors.initials: T
authors.lastname: Perkmann
authors.forename: Robert
authors.initials: R
authors.lastname: Jarai
authors.forename: Sylvia
authors.initials: S
authors.lastname: Archan
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tentzeris
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Helfried
authors.initials: H
authors.lastname: Metzler
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors; D018570:Risk Assessment / Q000379:methods*; D014652:Vascular Diseases / Q000097:blood / Q000601:surgery*; D014656:Vascular Surgical Procedures
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D011498:Protein Precursors; C048197:copeptins