title: Renal function interferes with copeptin in prediction of major adverse cardiac events in patients undergoing vascular surgery.
abstract: OBJECTIVE
  Precise perioperative risk stratification is important in vascular surgery patients who are at high risk for major adverse cardiovascular events (MACE) peri- and postoperatively. In clinical practice, the patient's perioperative risk is predicted by various indicators, e.g. revised cardiac index (RCRI) or modifications thereof. Patients suffering from chronic kidney disease (CKD) are stratified into a higher risk category. We hypothesized that Copeptin as a novel biomarker for hemodynamic stress could help to improve the prediction of perioperative cardiovascular events in patients undergoing vascular surgery including patients with chronic kidney disease.
  
  
  METHODS
  477 consecutive patients undergoing abdominal aortic, peripheral arterial or carotid surgery from June 2007 to October 2012 were prospectively enrolled. Primary endpoint was 30-day postoperative major adverse cardiovascular events (MACE).
  
  
  RESULTS
  41 patients reached the primary endpoint, including 63.4% aortic, 26.8% carotid, and 9.8% peripheral surgeries. Linear regression analysis showed that RCRI (P< .001), pre- (P< .001), postoperative Copeptin (P< .001) and Copeptin level change (P= .001) were associated with perioperative MACE, but CKD remained independently associated with MACE and Copeptin levels. Multivariate regression showed that increased Copeptin levels added risk predictive information to the RCRI (P= .003). Especially in the intermediate RCRI categories was Copeptin significantly associated with the occurrence of MACE. (P< .05 Kruskal Wallis test). Subdivision of the study cohort into CKD stages revealed that preoperative Copeptin was significantly associated with CKD stages (P< .0001) and preoperative Copeptin measurements could not predict MACE in patients with more severe CKD stages.
  
  
  CONCLUSIONS
  Preoperative Copeptin loses its risk predictive potential for perioperative MACE in patients with chronic kidney disease undergoing vascular surgery.
authors: Division of Vascular & Endovascular Surgery, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Claudia
authors: C
authors: Schrimpf
authors: Department for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors: Hans-Joerg
authors: HJ
authors: Gillmann
authors: Department for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors: Bianca
authors: B
authors: Sahlmann
authors: Department for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors: Antje
authors: A
authors: Meinders
authors: Department for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors: Jan
authors: J
authors: Larmann
authors: Division of Vascular & Endovascular Surgery, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Mathias
authors: M
authors: Wilhelmi
authors: Division of Vascular & Endovascular Surgery, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Thomas
authors: T
authors: Aper
authors: Division of Vascular & Endovascular Surgery, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Saad
authors: S
authors: Rustum
authors: Department for Clinical Chemistry, Hannover Medical School, Hannover, Germany.
authors: Ralf
authors: R
authors: Lichtinghagen
authors: Department for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors: Gregor
authors: G
authors: Theilmeier
authors: Division of Vascular & Endovascular Surgery, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Omke E
authors: OE
authors: Teebken
mesh_terms: D000368:Aged; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006020:Glycopeptides / Q000097:blood*; D006331:Heart Diseases / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications; D011379:Prognosis; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins