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Open Access Research article

Risk stratification in emergency patients by copeptin

Kasper Iversen37*, Jens P Gøtze2, Morten Dalsgaard3, Henrik Nielsen4, Søren Boesgaard1, Morten Bay5, Vibeke Kirk6, Olav W Nielsen4 and Lars Køber1

Author Affiliations

1 Department of Cardiology, Rigshospitalet, Copenhagen, Denmark

2 Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark

3 Departments of Cardiology and Endocrinology, Hillerød Hospital, Hillerød, Denmark

4 Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark

5 Department of Cardiology, Frederiksberg Hospital, Copenhagen, Denmark

6 Department of Oncology, Herlev Hospital, Copenhagen, Denmark

7 Department of Cardiology, Hillerød Hospital, Dyrehavevej 29, DK-3100 Hillerød, Denmark

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BMC Medicine 2014, 12:80  doi:10.1186/1741-7015-12-80

Published: 16 May 2014

Abstract

Background

Rapid risk stratification is a core task in emergency medicine. Identifying patients at high and low risk shortly after admission could help clinical decision-making regarding treatment, level of observation, allocation of resources and post discharge follow-up. The purpose of the present study was to determine short-, mid- and long-term mortality by plasma measurement of copeptin in unselected admitted patients.

Method

Consecutive patients >40-years-old admitted to an inner-city hospital were included. Within the first 24 hours after admission, a structured medical interview was conducted and self-reported medical history was recorded. All patients underwent a clinical examination, an echocardiographic evaluation and collection of blood for later measurement of risk markers.

Results

Plasma for copeptin measurement was available from 1,320 patients (average age 70.5 years, 59.4% women). Median follow-up time was 11.5 years (range 11.0 to 12.0 years). Copeptin was elevated (that is, above the 97.5 percentile in healthy individuals).

Mortality within the first week was 2.7% (17/627) for patients with elevated copeptin (above the 97.5 percentile, that is, >11.3 pmol/L) compared to 0.1% (1/693) for patients with normal copeptin concentrations (that is, ≤11.3 pmol/L) (P <0.01). Three-month mortality was 14.5% (91/627) for patients with elevated copeptin compared to 3.2% (22/693) for patients with normal copeptin. Similar figures for one-year mortality and for the entire observation period were 27.6% (173/627) versus 8.7% (60/693) and 82.9% (520/527) versus 57.5% (398/693) (P <0.01 for both), respectively.

Using multivariable Cox regression analyses shows that elevated copeptin was significantly and independently related to short-, mid- and long-term mortality. Adjusted hazard ratios were 2.4 for three-month mortality, 1.9 for one-year mortality and 1.4 for mortality in the entire observation period.

Conclusions

In patients admitted to an inner-city hospital, copeptin was strongly associated with short-, mid- and long-term mortality. The results suggest that rapid copeptin measurement could be a useful tool for both disposition in an emergency department and for mid- and long-term risk assessment.

Keywords:
Biomarker; Mortality; Inflammation