Copeptin may be useful in identifying normotensive patients with pulmonary embolism (PE) who are at a higher risk for a PE-related adverse outcome, and who may be candidates for more aggressive treatment with thrombolytic therapy, according to a study published by the European Respiratory Journal.
Researchers performed a post hoc analysis of 843 patients prospectively included in 3 European cohorts (Spain, Poland, and Germany) to externally validate the prognostic potential of copeptin in the diagnosis of normotensive patients with PE at a higher risk for an adverse 30-day outcome. An adverse 30-day outcome was the primary outcome observed in this study, which included a PE-related death, catecholamine administration, mechanical ventilation, and/or cardiopulmonary resuscitation. Secondary outcomes included a PE-related death or all-cause death within 30 days.
The primary outcome, all-cause death and PE-related death, occurred within the first 30 days in 21 (2.5%; 95% CI, 1.5%-3.8%), 36 (4.3%; 95% CI, 3.0%-5.9%), and 12 (1.4%; 95% CI, 0.7%-2.5%) patients, respectively.
Researchers found that patients with copeptin levels ≥24 pmol/L had more frequent adverse outcomes or died from PE compared with patients with copeptin levels <24 pmol/L (7.2% [95% CI, 3.9%-12.0%] vs 1.2% [95% CI, 0.5%-2.4%; P <.001] and 4.4% [95% CI, 1.9%-8.5%] vs 0.6% [95% CI, 0.2%-1.5%; P = .001]), and was associated with a 6.3-fold increased risk for an adverse outcome and 7.6-fold increased risk for a PE-related death. After testing independently with each variable and then separately in multivariable logistic models, researchers identified copeptin ≥24 pmol/L to have an independent prognostic predictive value for adverse outcomes or a PE-related death.
The odds ratio (OR) for an adverse outcome and a PE-related death in patients classified to the highest risk group based on 3 different risk assessment strategies were as follows: biomarker-based strategy: OR, 7.0 (95% CI, 2.9-16.8; P <.001) and 8.6 (95% CI, 2.7-27.6; P <.001), respectively; the 2014 ESC algorithm: OR, 5.0 (95% CI, 2.0-12.6; P =.001) and 7.4 (95% CI, 2.0-27.7; P =.003), respectively; the modified 2014 ESC algorithm using copeptin instead of imaging: OR, 7.4 (95% CI, 3.1-18.0; P <.001) and 7.6 (95% CI, 2.4-24.2; P =.001), respectively; and 2014 ESC algorithm followed by measurement of copeptin: OR, 11.1 (95% CI, 4.6-27.1; P <.001) and 13.5 (95% CI, 4.2-43.6; P <.001), respectively.
The addition of copeptin to the 2014 ESC algorithm had a significantly higher OR for identifying both adverse outcomes and death in normotensive patients with PE compared with all other risk assessment strategies.
Researchers concluded that not only did copeptin ≥24 pmol/L have a good prognostic performance associated with a 6.3-fold increased risk for adverse outcomes and 7.6-fold increase for PE-related death, but it also was useful in identifying normotensive patients with PE at a higher risk for adverse outcomes, and optimized the risk stratification of normotensive PE when added to the 2014 ECS algorithm. Therefore, if the risks for adverse outcomes and death are identified early, the administration of a fibrinolytic therapy in normotensive patients with PE may reduce hemodynamic decompensation and death in this population. Clinicians should consider the use of copeptin in evaluating normotensive patients with PE who have a higher risk for an adverse event or death.
Hellenkamp K, Pruszczyk P, Jiménez D, et al. Prognostic impact of copeptin in pulmonary embolism: a multicenter validation study [published online April 19, 2018]. Eur Respir J. doi:10.1183/13993003.02037-2017