Original ArticleCopeptin Release in Cardiac Surgery–A New Biomarker to Identify Risk Patients?
Section snippets
Patients and Design
Between February and September 2015, the authors prospectively included 20 patients planned for various cardiac surgical procedures (Supplementary File 1; Table 1). The study was conducted as a prospective, longitudinal, observational study performed at one single cardiothoracic department at a university hospital.
Restricted Cohort Criteria
From the whole cohort, 1 restricted cohort of patients was analyzed separately as a “normal population.” Criteria for this cohort included: Normal preoperative copeptin value (<10
Clinical Management
Premedication and induction/maintenance of anesthesia were standardized. After an overnight fast, patients were premedicated with oxazepam, 5-to-10 mg orally, and paracetamol, 1 g orally. General anesthesia was induced with thiopental and fentanyl intravenously (IV). Rocuronium bromide IV was used for neuromuscular block. Anesthesia was maintained with isoflurane and intermittent fentanyl, and the patients were normoventilated. Patients were managed surgically with standard techniques for
Statistics
The emerging data are presented as mean ± SD, median and interquartile range (IQR) or proportions as appropriate. Analysis for the copeptin release curve was done using Friedmans ANOVA. Wilcoxons test with Bonferroni correction was used for analysis of differences between levels within the copeptin release curve. Bonferroni correction was adjusted based on 10 comparisons within the release curve. The authors considered differences statistically significant if p < 0.05 (for the Friedman test p <
Ethics
After written informed consent the patients were enrolled into the study. The study was performed according to the Helsinki Declaration of Human Rights. The study was approved by the Regional Ethical Review Board in Linköping (EPN 2014/50-31).
Baseline Data
The mean age in the total study population (n = 20) was 71 ± 8 years and 20% were females. Preoperative risk-scoring model EuroSCORE II19 was median 1.7 (IQR: 1.3-2.7) and preoperative NT-proBNP was 740 ng/L (IQR: 175-1,200). The mean CPB time was 91 ± 29 minutes. In-hospital stay was 9 days (IQR: 8-14). There were no in-hospital or 30-day mortality. Detailed data are presented in Table 1, Table 2.
Temporal Release Pattern of Copeptin – Total Study Population (n = 20)
The preoperative copeptin concentration in the total study population was 7.0 pmol/L (IQR:
Discussion
The main findings in this study were that all patients, regardless of type of cardiac surgery, had a similar kinetic release curve, with an early major rise of copeptin concentrations generally peaking at weaning from CPB or upon arrival in the ICU. Among patients with a normal preoperative copeptin concentration and uneventful course, the postoperative copeptin concentrations returned to normal values within 3-to-4 days after surgery.
The results in this study were consistent with previous
Limitations of the Study
This study included 20 patients undergoing cardiac surgery, all on CPB. The presentation is strictly descriptive. Due to the limited number of patients in this study it was not possible to make conclusions about prognostic effects based on different concentrations of copeptin in the perioperative course. The patients in the study consisted of an unselected cohort of patients. This meant that were are different cardiac surgery procedures that made the cohort inhomogeneous. This aspect has to be
Conclusions
In conclusion, this study showed that regardless of cardiac surgical procedure and perioperative course, all patients had an early major rise of copeptin concentrations, generally peaking at weaning from CBP or upon arrival in the ICU. In patients with normal copeptin concentration preoperatively and uneventful course, the postoperative copeptin concentrations decreased to normal values within 3-to-4 days after cardiac surgery. Furthermore, this restricted “normal cohort” generally tended to
Acknowledgments
This work was supported by ALF Grants, region Östergötland. We are grateful to Mats Fredriksson, PhD, senior lecturer at the Linköping Academic Research Centre, for professional assistance with statistics.
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