Original Article
Copeptin Release in Cardiac Surgery–A New Biomarker to Identify Risk Patients?

https://doi.org/10.1053/j.jvca.2017.06.011Get rights and content

Objective

To describe the dynamics of copeptin in open cardiac surgery during the perioperative course.

Setting

Single tertiary hospital.

Participants

Twenty patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB).

Interventions

No intervention.

Measurements and Main Results

Copeptin concentrations were measured pre-, peri-, and postoperatively until day 6 after surgery. Patients were analyzed as a whole cohort (n = 20) and in a restricted “normal cohort” consisting of patients with normal preoperative copeptin concentration (<10 pmol/L) and perioperative uneventful course (n = 11). In the whole cohort, preoperative copeptin concentration was 7.0 pmol/L (interquartile range: 3.1-11 pmol/L). All patients had an early rise of copeptin, with 80% having peak copeptin concentration at weaning from CPB or upon arrival in the intensive care unit. Patients in the “normal cohort” had copeptin concentration at weaning from CPB of 194 pmol/L (98-275), postoperative day 1, 27 pmol/L (18-31); and day 3, 8.9 pmol/L (6.3-12).

Conclusions

Regardless of cardiac surgical procedure and perioperative course, all patients had an early significant rise of copeptin concentrations, generally peaking at weaning from CBP or upon arrival in the intensive care unit. Among 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, the restricted “normal cohort” generally tended to display lower levels of copeptin concentration postoperatively. Further studies may evaluate whether copeptin can be a tool in identifying risk patients in cardiac surgery.

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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