title: Blood levels of copeptin on admission predict outcomes in out-of-hospital cardiac arrest survivors treated with therapeutic hypothermia.
abstract: BACKGROUND
  Prognostic stratification of cardiac arrest survivors is essential for the selection of the most appropriate therapeutic strategy. However, accurate early outcome predictions for this patient population remain challenging. At present, there is a lack of data examining the prognostic value of C-terminal provasopressin (copeptin) in cardiac arrest survivors.
  
  
  METHODS
  A group of 40 out-of-hospital cardiac arrest survivors who were treated with endovascular hypothermia was analyzed. Copeptin levels were measured in blood samples taken at admission using a commercially available immunoassay. Neurological outcome was assessed at 30 days post admission according to the Cerebral Performance Category (CPC): CPC 1, no neurological deficit; CPC 2, mild to moderate dysfunction; CPC 3, severe dysfunction; CPC 4, coma; and CPC 5, death.
  
  
  RESULTS
  Copeptin levels were significantly lower in patients with CPC 1 compared with CPC 2 or CPC 3 to CPC 5 (74.3 ± 14.4 pmol/l, 219.8 ± 33.9 pmol/l and 302.7 ± 52.1 pmol/l, respectively; P < 0.0001). Using an optimal cutoff value ≤ 217.9 pmol/l calculated from the receiver operating characteristic curve (area under curve = 0.801, 95% confidence interval = 0.644 to 0.910; P = 0.0001), the sensitivity of predicting survival with good neurological outcome was 78.6% and the specificity was 75.0%. Multiple logistic regression analysis revealed that a copeptin level > 217.9 pmol/l was an independent predictor of severe neurological dysfunction or death, with an adjusted odds ratio of 27.00 (95% confidence interval = 2.27 to 321.68; P = 0.009).
  
  
  CONCLUSIONS
  The present study found that copeptin levels have a significant prognostic value at the time of hospital admission, and are a promising diagnostic tool for predicting outcomes in out-of-hospital cardiac arrest survivors.
authors.forename: Petr
authors.initials: P
authors.lastname: Ostadal
authors.forename: Andreas
authors.initials: A
authors.lastname: Kruger
authors.forename: Vladimira
authors.initials: V
authors.lastname: Zdrahalova
authors.forename: Marek
authors.initials: M
authors.lastname: Janotka
authors.forename: Dagmar
authors.initials: D
authors.lastname: Vondrakova
authors.forename: Petr
authors.initials: P
authors.lastname: Neuzil
authors.forename: Miroslav
authors.initials: M
authors.lastname: Prucha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D007036:Hypothermia, Induced / Q000401:mortality / Q000639:trends*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D010343:Patient Admission / Q000639:trends*; D011237:Predictive Value of Tests; D017741:Survivors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins