title: Plasma copeptin in the assessment of febrile neutropenia.
abstract: Copeptin, the surrogate marker of arginine vasopressin (AVP), has been suggested to be a useful biomarker in monitoring sepsis reflecting hemodynamic imbalance and stress state. This prospective study conducted at a hematology ward in a Finnish University Hospital aimed to investigate whether plasma copeptin predicts the development of complicated course of neutropenic fever (bacteremia or need for treatment at intensive care unit) in 100 hematological patients experiencing their first neutropenic fever episode after intensive chemotherapy for hematological malignancy. Contrary to study presumptions, not elevated copeptin but the lack of a proper initial increase of plasma copeptin (<0.02 ng/mL from day 0 to day 1) predicted blood culture positive sepsis (p=0.023) and gram-negative bacteremia (p=0.045). No correlation was observed with plasma sodium, blood pressure or evaluated osmolality. Plasma copeptin correlated inversely with the same day pentraxin 3 on day 0-day 2 (all p-values <0.001) and with C-reactive protein on day 1 (p=0.015). In conclusion, copeptin did not correlate with disease severity, but the lack of a proper initial increase was associated with bacteremic complications of febrile neutropenia in hematological patients. The findings suggest the possibility of central dysregulation of AVP release and do not support the use of copeptin as a biomarker of septic complications in this patient group.
authors.affiliation: Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, FI-70211 Kuopio, Finland.
authors.forename: Anna-Kaisa
authors.initials: AK
authors.lastname: Purhonen
authors.forename: Matti
authors.initials: M
authors.lastname: Vänskä
authors.forename: Sari
authors.initials: S
authors.lastname: Hämäläinen
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
authors.forename: Maija
authors.initials: M
authors.lastname: Lehtikangas
authors.forename: Taru
authors.initials: T
authors.lastname: Kuittinen
authors.forename: Tapio
authors.initials: T
authors.lastname: Nousiainen
authors.forename: Irma
authors.initials: I
authors.lastname: Koivula
authors.forename: Esa
authors.initials: E
authors.lastname: Jantunen
authors.forename: Auni
authors.initials: A
authors.lastname: Juutilainen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000097:blood* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005334:Fever / Q000097:blood* / Q000209:etiology; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood* / Q000209:etiology; D011446:Prospective Studies; D000683:Serum Amyloid P-Component / Q000378:metabolism; D055815:Young Adult; D000099153:Pentraxins
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D002097:C-Reactive Protein; D006020:Glycopeptides; D006854:Hydrocortisone; D000683:Serum Amyloid P-Component; D000099153:Pentraxins; C048197:copeptins