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Peri-operative copeptin concentrations and their association with myocardial injury after vascular surgery: A

Firmin Kamber, Eckhard Mauermann, Esther Seeberger

European Journal of Anaesthesiology

|May 12, 2018

Insights

Postoperative copeptin levels significantly increase after vascular surgery and remain elevated for two days. Early postoperative copeptin measurements show promise for identifying patients at risk of myocardial injury.

Area of Science:

Cardiology
Biomarkers
Surgical Outcomes

Background:

Copeptin is a biomarker used to rule out myocardial infarction.
Pre-operative copeptin is linked to postoperative cardiac events.
The peri-operative time course and early diagnostic utility of copeptin for myocardial injury are not well understood.

Purpose of the Study:

To examine the peri-operative time course of copeptin levels.
To determine when copeptin concentrations return to pre-operative levels.
To explore the association between copeptin and myocardial injury within 48 hours post-surgery.

Main Methods:

Prospective, observational cohort study of 30 vascular surgery patients.
Serial peri-operative copeptin measurements taken at multiple time points.
Myocardial injury defined by increases in high-sensitivity cardiac troponin T.

Main Results:

Copeptin levels increased nearly eight-fold immediately after surgery and remained elevated for two days.
Postoperative copeptin was significantly higher in patients who experienced myocardial injury (P=0.02).
Immediate postoperative copeptin showed potential diagnostic utility (AUC=0.743).

Conclusions:

Copeptin concentrations significantly increase after vascular surgery, normalizing by the second postoperative day.
Elevated postoperative copeptin is associated with myocardial injury.
Immediate postoperative copeptin measurement is a promising tool for identifying myocardial injury risk.

Read full analysis

Abstract

Background:

Copeptin levels in conjunction with cardiac troponin may be used to rule out early myocardial infarction in patients presenting with chest pain. Raised pre-operative copeptin has been shown to be associated with postoperative cardiac events. However, very little is known about the peri-operative time course of copeptin or the feasibility of very early postoperative copeptin measurement to diagnose or rule-out myocardial injury.

Objectives:

In this preparatory analysis for a larger trial, we sought to examine the time course of peri-operative copeptin and identify the time at which concentrations returned to pre-operative levels. Second, in an explorative analysis, we sought to examine the association of copeptin in general and at various time points with myocardial injury occurring within the first 48 h.

Design:

Preparatory analysis of a prospective, observational cohort study.

Setting:

Single university centre from February to July 2016.

Patients:

A total of 30 consecutive adults undergoing vascular surgery.

Intervention:

Serial peri-operative copeptin measurements.

Main Outcome Measure:

We measured copeptin concentrations before and immediately after surgery (0 h), then at 2, 4, 6 and 8 h after surgery and on the first and second postoperative day. Postoperative concentrations were compared with pre-operative levels with a Wilcoxon signed-rank test. Second, we explored an association between postoperative copeptin concentrations and myocardial injury by the second postoperative day. Myocardial injury was defined as a 5 ng l increase between pre-operative and postoperative high-sensitivity cardiac troponin T with an absolute peak of at least 20 ng l.

Results:

Immediate postoperative copeptin concentrations (median [interquartile range]) increased nearly eight-fold from pre-operative values (8.5 [3.6 to 13.8] to 64.75 pmol l [29.6 to 258.7]; P < 0.001). Copeptin concentrations remained elevated until returning to baseline on the second postoperative day. Postoperative copeptin was significantly higher in patients experiencing myocardial injury than in those who did not (P = 0.02). The earliest most promising single time point for diagnosis may be immediately after surgery (0 h). The receiver-operating characteristics curve for immediate postoperative copeptin and myocardial injury by the second postoperative day was 0.743 (95% confidence interval 0.560 to 0.926).

Conclusion:

Copeptin concentrations are greatly increased after vascular surgery and remain so until the 2nd postoperative day. Postoperative copeptin concentrations appear to be higher in patients who go on to exhibit myocardial injury. Immediate postoperative copeptin concentrations show promise for eliminating or identifying those at risk of myocardial injury.

Trial Registration:

ClinicalTrials.gov identifier: NCT02687776, Mauermann/Lurati Buse.

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