title: Outcome prediction and temperature dependency of MR-proANP and Copeptin in comatose resuscitated patients.
abstract: OBJECTIVE
  To evaluate the prognostic potential of serum C-terminal provasopressin (CT-proAVP or Copeptin) and midregional pro-A-type natriuretic peptide (MR-proANP) to predict neurological outcome following resuscitation from cardiac arrest.
  
  
  METHODS
  In this prospective observational study, we employed novel ultra sensitive immunoassay technology to examine serial serum samples from 134 cardiac arrest patients. Patients were either allocated to mild therapeutic hypothermia using an endovascular device or normothermia. Serial blood samples were obtained from resuscitated cardiac arrest survivors during their first 7 days in an intensive care unit, and serum Copeptin and MR-proANP were measured. Cerebral function assessments were made using cerebral performance categorization (CPC) at discharge from hospital. Copeptin and MR-proANP data were analyzed using dichotomized CPC scores (1-2 versus 3-5).
  
  
  RESULTS
  Sixty-nine patients (51%) had a poor outcome (CPC 3-5) at hospital discharge. MR-proANP and Copeptin peaked on day 1 (i.e. 0-24h) with the medians being 249.3pmol/L and 77.2pmol/L, respectively. In the first 48h maximum levels of MR-proANP and Copeptin showed an AUC in the ROC of 0.743 (95% CI: 0.658-0.828) and 0.677 (95% CI: 0.583-0.771). Binary logistic regression revealed MR-proANP and Copeptin within 48h after ROSC being significantly associated with functional outcome (p<0.05). Copeptin within 48h was also associated with outcome in the hypothermia group (p<0.05).
  
  
  CONCLUSIONS
  Systemic levels of MR-proANP and Copeptin peak early in cardiac arrest patients in the 48h post-resuscitation period. MR-proANP and Copeptin were highly predictive for poor outcome in comatose resuscitated patients.
authors.affiliation: Department of Neurology, Medical University of Innsbruck, Austria. Electronic address: gregor.broessner@i-med.ac.at.
authors.forename: Gregor
authors.initials: G
authors.lastname: Broessner
authors.affiliation: Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Hasslacher
authors.affiliation: Department of Neurology, Medical University of Innsbruck, Austria.
authors.forename: Ronny
authors.initials: R
authors.lastname: Beer
authors.affiliation: Department of Neurology, Medical University of Innsbruck, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Lackner
authors.affiliation: Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Austria.
authors.forename: Georg Franz
authors.initials: GF
authors.lastname: Lehner
authors.affiliation: Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Austria.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Harler
authors.affiliation: Department of Neurology, Medical University of Innsbruck, Austria.
authors.forename: Alois
authors.initials: A
authors.lastname: Schiefecker
authors.affiliation: Department of Neurology, Medical University of Innsbruck, Austria.
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.affiliation: Department of Neurology, Medical University of Innsbruck, Austria.
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfausler
authors.affiliation: Central Institute of Medicinal and Chemical Laboratory Diagnostics, Innsbruck Regional Hospital, Medical University of Innsbruck, Austria.
authors.forename: Angelika
authors.initials: A
authors.lastname: Hammerer-Lercher
authors.affiliation: Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Joannidis
mesh_terms: D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006323:Heart Arrest / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012151:Resuscitation
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins; C552580:midregional pro-atrial natriuretic peptide, human; D009320:Atrial Natriuretic Factor
keywords: Biomarkers; Copeptin; MR-proANP; Prognostication; Targeted temperature management; Therapeutic hypothermia