title: Plasma copeptin, a possible prognostic marker in cirrhosis.
abstract: OBJECTIVE
  Copeptin, secreted stoichiometrically with vasopressin, demonstrated its prognostic role in various diseases other than cirrhosis.
  
  
  METHODS
  We investigated the association between severity of cirrhosis and plasma concentrations of copeptin, and the prognostic value of copeptin in 95 non-septic cirrhotic patients (34 Child-Pugh A, 29 CP-B, 32 CP-C), 30 septic patients with a Child-Pugh >8 ('group D'), and 16 healthy volunteers. Patients were followed for at least 12 months to assess the composite endpoint death/liver transplantation.
  
  
  RESULTS
  Median copeptin concentrations (interquartile range) increased through healthy volunteers group [5.95 (3.76-9.43) pmol/L] and 'group D' patients [18.81 (8.96-36.66) pmol/L; P < 0.001)]. During a median follow-up of 11.0 ± 6.1 months, 28 non-transplanted patients died and eight were transplanted. In receiver operated characteristic curves analysis, the area under the curve values were as follows: Child-Pugh score 0.80 (95% CI: 0.71-0.86), model of end-stage liver disease (MELD) score 0.80 (0.70-0.86), C-reactive protein (CRP) 0.71 (0.60-0.80) and copeptin 0.70 (0.57-0.79). By stratifying the values of these variables into tertiles, the risk of death/liver transplantation for patients belonging to the highest tertile of copeptin (>13 pmol/L) was high (Log-rank test: P = 0.0002) and 2.3-fold higher than for patients with lower concentrations after adjusting for MELD score (>21) and CRP (>24 mg/L) in a Cox model. Other potential predictors (age, total cholesterol, natraemia and serum free cortisol) did not reach a significant level.
  
  
  CONCLUSIONS
  In cirrhotic patients, copeptin concentrations increased along with the severity of liver disease. In our cohort, the 1-year mortality or liver transplantation was predicted by high MELD score and high concentrations of CRP and copeptin.
authors.affiliation: Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon, France.
authors.forename: José-Philippe
authors.initials: JP
authors.lastname: Moreno
authors.forename: Emilie
authors.initials: E
authors.lastname: Grandclement
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Monnet
authors.forename: Béatrice
authors.initials: B
authors.lastname: Clerc
authors.forename: Arnaud
authors.initials: A
authors.lastname: Agin
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cervoni
authors.forename: Carine
authors.initials: C
authors.lastname: Richou
authors.forename: Claire
authors.initials: C
authors.lastname: Vanlemmens
authors.forename: Stavros
authors.initials: S
authors.lastname: Dritsas
authors.forename: Gilles
authors.initials: G
authors.lastname: Dumoulin
authors.forename: Vincent
authors.initials: V
authors.lastname: Di Martino
authors.forename: Thierry
authors.initials: T
authors.lastname: Thevenot
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000175:diagnosis; D012720:Severity of Illness Index; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins; D002097:C-Reactive Protein