Usefulness of Pre-Operative Copeptin Concentrations to Predict Post-Operative Outcome After Major Vascular Surgery

被引:29
作者
Jarai, Rudolf [1 ]
Mahla, Elisabeth [2 ]
Perkmann, Thomas [3 ]
Jarai, Robert [4 ]
Archan, Sylvia [2 ]
Tentzeris, Ioannis [1 ]
Huber, Kurt [1 ]
Metzler, Helfried [2 ]
机构
[1] Wilhelminenhosp, Dept Med Cardiol & Emergency Med 3, Vienna, Austria
[2] Med Univ, Dept Anesthesiol & Intens Care Med, Graz, Austria
[3] Med Univ Vienna, Dept Lab Med, Vienna, Austria
[4] Univ Pecs, Dept Psychol, Pecs, Hungary
关键词
ACUTE MYOCARDIAL-INFARCTION; CHRONIC HEART-FAILURE; NATRIURETIC PEPTIDE; PROGNOSTIC MARKER; NONCARDIAC SURGERY; RISK-ASSESSMENT; CARDIAC RISK; VASOPRESSIN; VALIDATION; PRECURSOR;
D O I
10.1016/j.amjcard.2011.06.024
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The aim of this study was to investigate whether preoperative determination of plasma copeptin levels in addition to plasma N-terminal pro B-type natriuretic peptide (NT-pro-BNP) could help improve risk stratification in patients who undergo major vascular surgery. One hundred ninety-eight consecutive patients who underwent major vascular surgery (58.6% infrainguinal aortic reconstruction, 23.7% abdominal aortic aneurysm surgery, 17.7% carotid endarterectomy) were included in this study. Patients were monitored for in-hospital and long-term (2-years) major adverse cardiac events, consisting of cardiac death, nonfatal myocardial infarction, and emergent coronary revascularization. Overall, 40 patients (20.2%) reached the primary end point, and most of these events occurred during the index hospital stay (n = 18 [45%]). In univariate Cox regression analysis, increasing concentrations of copeptin were significant determinants of outcome as a continuous variable (hazard ratio [HR] 1.012, p = 0.005) and as a dichotomized variable according to the recommended cutoff of 14.0 pmol/L (HR 4.116, p <0.001). Subgroup analyses revealed that especially patients at low estimated risk according to plasma NT-pro-BNP levels were at significantly higher risk for worse outcomes with higher copeptin levels (HR 5.983, p = 0.002). In multivariate Cox regression analysis, copeptin concentrations >14 pmol/L were significant independent predictors of outcome (HR 2.842, p = 0.002) in addition to type of surgery, history of myocardial infarction, elevated levels of cardiac troponin T, and NT-pro-BNP levels. In conclusion, the results of this study suggest that preoperative determination of this new biomarker could substantially improve prediction of perioperative and postoperative outcomes in vascular surgery patients. (C) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;108:1188-1195)
引用
收藏
页码:1188 / 1195
页数:8
相关论文
共 20 条
[1]  
DONG XQ, J TRAUMA IN PRESS
[2]   Plasma Copeptin and the Risk of Diabetes Mellitus [J].
Enhorning, Sofia ;
Wang, Thomas J. ;
Nilsson, Peter M. ;
Almgren, Peter ;
Hedblad, Bo ;
Berglund, Goran ;
Struck, Joachim ;
Morgenthaler, Nils G. ;
Bergmann, Andreas ;
Lindholm, Eero ;
Groop, Leif ;
Lyssenko, Valeria ;
Orho-Melander, Marju ;
Newton-Cheh, Christopher ;
Melander, Olle .
CIRCULATION, 2010, 121 (19) :2102-U51
[3]   Current guideline-based preoperative evaluation provides the best management of patients undergoing noncardiac surgery [J].
Gregoratos, Gabriel .
CIRCULATION, 2008, 117 (24) :3134-3144
[4]  
Katan M, 2008, NEUROENDOCRINOL LETT, V29, P341
[5]   Copeptin: A Novel, Independent Prognostic Marker in Patients with Ischemic Stroke [J].
Katan, Mira ;
Fluri, Felix ;
Morgenthaler, Nils G. ;
Schuetz, Philipp ;
Zweifel, Christian ;
Bingisser, Roland ;
Mueller, Klaus ;
Meckel, Stephan ;
Gass, Achim ;
Kappos, Ludwig ;
Steck, Andreas J. ;
Engelter, Stefan T. ;
Mueller, Beat ;
Christ-Crain, Mirjam .
ANNALS OF NEUROLOGY, 2009, 66 (06) :799-808
[6]   Copeptin:: a new and promising diagnostic and prognostic marker [J].
Katan, Mira ;
Mueller, Beat ;
Christ-Crain, Mirjam .
CRITICAL CARE, 2008, 12 (02)
[7]   Effects of oral tolvaptan in patients hospitalized for worsening heart failure - The EVEREST outcome trial [J].
Konstam, Marvin A. ;
Gheorghiade, Mihai ;
Burnett, John C., Jr. ;
Grinfeld, Liliana ;
Maggioni, Aldo P. ;
Swedberg, Karl ;
Udelson, James E. ;
Zannad, Faiez ;
Cook, Thomas ;
Ouyang, John ;
Zimmer, Christopher ;
Orlandi, Cesare .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2007, 297 (12) :1319-1331
[8]   Perioperative Myocardial Infarction [J].
Landesberg, Giora ;
Beattie, W. Scott ;
Mosseri, Morris ;
Jaffe, Allan S. ;
Alpert, Joseph S. .
CIRCULATION, 2009, 119 (22) :2936-2944
[9]   Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery [J].
Lee, TH ;
Marcantonio, ER ;
Mangione, CM ;
Thomas, EJ ;
Polanczyk, CA ;
Cook, EF ;
Sugarbaker, DJ ;
Donaldson, MC ;
Poss, R ;
Ho, KKL ;
Ludwig, LE ;
Pedan, A ;
Goldman, L .
CIRCULATION, 1999, 100 (10) :1043-1049
[10]   Development and validation of a Bayesian model for perioperative cardiac risk assessment in a cohort of 1,081 vascular surgical candidates [J].
LItalien, GJ ;
Paul, SD ;
Hendel, RC ;
Leppo, JA ;
Cohen, MC ;
Fleisher, LA ;
Brown, KA ;
Zarich, SW ;
Cambria, RP ;
Cutler, BS ;
Eagle, KA .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1996, 27 (04) :779-786