title: Copeptin Predicts Mortality in Critically Ill Patients.
abstract: BACKGROUND
  Critically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual's stress level and was associated with outcome in various disease entities. The aim of this study was to analyze whether circulating levels of copeptin at ICU admission are associated with 30-day mortality.
  
  
  METHODS
  In this single-center prospective observational study including 225 consecutive patients admitted to a tertiary medical ICU at a university hospital, blood was taken at ICU admission and copeptin levels were measured using a commercially available automated sandwich immunofluorescent assay.
  
  
  RESULTS
  Median acute physiology and chronic health evaluation II score was 20 and 30-day mortality was 25%. Median copeptin admission levels were significantly higher in non-survivors as compared with survivors (77.6 IQR 30.7-179.3 pmol/L versus 45.6 IQR 19.6-109.6 pmol/L; p = 0.025). Patients with serum levels of copeptin in the third tertile at admission had a 2.4-fold (95% CI 1.2-4.6; p = 0.01) increased mortality risk as compared to patients in the first tertile. When analyzing patients according to cause of admission, copeptin was only predictive of 30-day mortality in patients admitted due to medical causes as opposed to those admitted after cardiac surgery, as medical patients with levels of copeptin in the highest tertile had a 3.3-fold (95% CI 1.66.8, p = 0.002) risk of dying independent from APACHE II score, primary diagnosis, vasopressor use and need for mechanical ventilation.
  
  
  CONCLUSIONS
  Circulating levels of copeptin at ICU admission independently predict 30-day mortality in patients admitted to a medical ICU.
authors.affiliation: Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Vienna, Austria.|Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.
authors.forename: Konstantin A
authors.initials: KA
authors.lastname: Krychtiuk
authors.affiliation: Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Honeder
authors.affiliation: Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Max
authors.initials: M
authors.lastname: Lenz
authors.affiliation: Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.affiliation: Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Vienna, Austria.|Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.|Core Facilities, Medical University of Vienna, Vienna, Austria.
authors.forename: Johann
authors.initials: J
authors.lastname: Wojta
authors.affiliation: Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Heinz
authors.affiliation: Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.|3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital Vienna, Austria.|Sigmund Freud Private University. Medical School, Vienna, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.affiliation: Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Walter S
authors.initials: WS
authors.lastname: Speidl
mesh_terms: D018806:APACHE; D000368:Aged; D015415:Biomarkers; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006331:Heart Diseases / Q000097:blood; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016019:Survival Analysis; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D014662:Vasoconstrictor Agents; C048197:copeptins