Copeptin as a marker of relative arginine vasopressin deficiency after pediatric cardiac surgery

被引:15
作者
Mastropietro, Christopher W. [1 ]
Mahan, Meredith [2 ]
Valentine, Kevin M. [1 ]
Clark, Jeff A. [1 ]
Hines, Patrick C. [1 ]
Walters, Henry L., III [3 ]
Delius, Ralph E. [3 ]
Sarnaik, Ashok P. [1 ]
Rossi, Noreen F. [4 ,5 ]
机构
[1] Wayne State Univ, Childrens Hosp Michigan, Dept Pediat, Div Crit Care, Detroit, MI 48201 USA
[2] Henry Ford Hlth Syst, Dept Publ Hlth Sci, Div Biostat, Detroit, MI 48202 USA
[3] Wayne State Univ, Childrens Hosp Michigan, Dept Cardiovasc Surg, Detroit, MI 48201 USA
[4] Wayne State Univ, John D Dingell VAMC, Dept Internal Med, Detroit, MI 48201 USA
[5] Wayne State Univ, John D Dingell VAMC, Dept Physiol, Detroit, MI 48201 USA
关键词
Arginine vasopressin; Copeptin; Pediatrics; Cardiopulmonary bypass; Cardiac surgical procedures; Postoperative care; VASODILATORY SHOCK; CHILDREN; HEART; PRECURSOR; INFUSION; INFANTS;
D O I
10.1007/s00134-012-2731-9
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Relative arginine vasopressin (AVP) deficiency after pediatric cardiac surgery has recently been described. Copeptin, a more stable and easily measured product of pro-AVP processing, may be a means of identifying these patients. We aimed to determine if copeptin was correlated with AVP in these children and whether it can be a surrogate marker of relative AVP deficiency. Patients < 6 years of age with basic Aristotle scores a parts per thousand yen7 requiring surgery with cardiopulmonary bypass were prospectively enrolled. Plasma AVP and copeptin concentrations were measured pre-cardiopulmonary bypass and 4 and 24 h post-cardiopulmonary bypass. Relative AVP deficiency was defined a priori based on our previous work as AVP < 9.2 pg/ml at 4 h post-cardiopulmonary bypass. Of 41 children enrolled, relative AVP deficiency was present in 13 (32 %). AVP and copeptin concentrations were significantly lower in these 13 children at 4 h post-cardiopulmonary bypass as compared to the other 28 patients. A significant positive association between plasma AVP and copeptin concentrations over time was determined. Based on log-transformed analyses, a 1 % increase in plasma AVP led to a 0.19 % increase in copeptin. Further, copeptin < 1.12 ng/ml at 4 h post-cardiopulmonary bypass had a sensitivity of 92 % and a negative predictive value of 95 % for relative AVP deficiency. Plasma AVP and copeptin are positively associated in children undergoing cardiac surgery. Copeptin may represent a useful means of identifying relative AVP deficiency in these patients.
引用
收藏
页码:2047 / 2054
页数:8
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