title: Plasma copeptin as biomarker of disease progression and prognosis in cirrhosis.
abstract: Research on vasopressin (AVP) in cirrhosis and its role in the assessment of prognosis has been hindered by the difficulty of measuring AVP levels accurately. Copeptin, a 39-aminoacid glycopeptide, is released from the neurohypophysis together with AVP. Copeptin could have a role as biomarker of prognosis in cirrhosis as it may reflect circulatory dysfunction. The aim of this study is to investigate the role of copeptin as biomarker of disease progression and prognosis in cirrhosis.
  
  
  
  This prospective study is divided in 2 study protocols including 321 consecutive patients. Plasma copeptin levels were measured in all patients at study inclusion. Protocol 1: to investigate the relationship of copeptin with kidney and circulatory function (56 patients). Protocol 2: to investigate the relationship between copeptin and prognosis, as assessed by the development of complications of cirrhosis or mortality at 3months (265 patients admitted to hospital for complications of cirrhosis).
  
  
  
  Patients with decompensated cirrhosis showed significantly higher plasma copeptin levels compared to those of patients with compensated cirrhosis. Copeptin levels had a significant positive correlation with model for end-satge liver disease (MELD) score, AVP, endogenous vasoconstrictor systems, and kidney function parameters. Patients developing complications of cirrhosis or mortality had significantly higher plasma copeptin levels compared to those of the remaining patients. Plasma copeptin levels were an independent predictive factor of both the development of complications and mortality at 3months. This was confirmed in a validation series of 120 patients.
  
  
  
  Copeptin is a novel biomarker of disease progression and prognosis in cirrhosis.
  
  
  
  Copeptin is a fragment of the vasopressin precursor, a hormone that is known to be increased in patients with cirrhosis and that plays a role in the development of complications of the disease. Vasopressin is difficult to measure, but copeptin is a more stable molecule and is easier to measure in blood. Solà and Kerbert and colleagues have shown in a series of 361 patients that copeptin is markedly increased in patients with cirrhosis who develop complications during the following 3months, compared to those patients who do not develop complications. Moreover, copeptin correlates with prognosis.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain. Electronic address: esola@clinic.cat.
authors.forename: Elsa
authors.initials: E
authors.lastname: Solà
authors.affiliation: Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Annarein J C
authors.initials: AJ
authors.lastname: Kerbert
authors.affiliation: Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Hein W
authors.initials: HW
authors.lastname: Verspaget
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Moreira
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Pose
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ruiz
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Cela
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Biochemistry and Molecular Genetics Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Morales-Ruiz
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: López
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Graupera
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Solé
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Huelin
authors.affiliation: EASL-CLIF Data Center, Barcelona, Spain.
authors.forename: Alex Amorós
authors.initials: AA
authors.lastname: Navarro
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Ariza
authors.affiliation: Liver Failure Group, UCL Institute of Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, United Kingdom.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jalan
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; School of Nursing, University of Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Fabrellas
authors.affiliation: Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Benten
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: de Prada
authors.affiliation: Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France.
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.affiliation: Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Biochemistry and Molecular Genetics Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Wladimiro
authors.initials: W
authors.lastname: Jimenez
authors.affiliation: Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Johan J
authors.initials: JJ
authors.lastname: van der Reijden
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Fernandez
authors.affiliation: Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: van Hoek
authors.affiliation: Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Minneke J
authors.initials: MJ
authors.lastname: Coenraad
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D015415:Biomarkers; D018450:Disease Progression; D006020:Glycopeptides; D006801:Humans; D008103:Liver Cirrhosis; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins
keywords: Biomarker; Circulatory dysfunction; Cirrhosis; Copeptin; Prognosis