Perioperative copeptin : predictive value and risk stratification in patients undergoing major noncardiac surgery-a prospective observational cohort study
© 2024. The Author(s)..
PURPOSE: Biomarkers can aid in perioperative risk stratification. While preoperative copeptin has been associated with adverse events, intraoperative information is lacking and this association may rather reflect a baseline risk. Knowledge about correlations between postoperative copeptin measurements and clinically relevant outcomes is scarce. We examined the association of perioperative copeptin concentrations with postoperative all-cause mortality and/or major adverse cardiac and cerebrovascular events (MACCE) at 12 months and 30 days as well as with perioperative myocardial injury (PMI).
METHODS: We conducted a prospective observational cohort study of adults undergoing noncardiac surgery with intermediate to high surgical risk in Basel, Switzerland, and Düsseldorf, Germany from February 2016 to December 2020. We measured copeptin and cardiac troponin before surgery, immediately after surgery (0 hr) and once between the second and fourth postoperative day (POD 2-4).
RESULTS: A primary outcome event of a composite of all-cause mortality and/or MACCE at 12 months occurred in 48/502 patients (9.6%). Elevated preoperative copeptin (> 14 pmol·L-1), immediate postoperative copeptin (> 90 pmol·L-1), and copeptin on POD 2-4 (> 14 pmol·L-1) were associated with lower one-year MACCE-free and/or mortality-free survival (hazard ratio [HR], 2.89; 95% confidence interval [CI], 1.62 to 5.2; HR, 2.07; 95% CI, 1.17 to 3.66; and HR, 2.47; 95% CI, 1.36 to 4.46, respectively). Multivariable analysis continued to show an association for preoperative and postoperative copeptin on POD 2-4. Furthermore, elevated copeptin on POD 2-4 showed an association with 30-day MACCE-free survival (HR, 2.15; 95% CI, 1.18 to 3.91). A total of 64 of 489 patients showed PMI (13.1%). Elevated preoperative copeptin was not associated with PMI, while immediate postoperative copeptin was modestly associated with PMI.
CONCLUSION: The results of the present prospective observational cohort study suggest that perioperative copeptin concentrations can help identify patients at risk for all-cause mortality and/or MACCE. Other identified risk factors were revised cardiac risk index, body mass index, surgical risk, and preoperative hemoglobin.
TRIAL REGISTRATION: ClinicalTrials.gov (NCT02687776); first submitted 9 February 2016.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:71 |
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| Enthalten in: |
Canadian journal of anaesthesia = Journal canadien d'anesthesie - 71(2024), 3 vom: 20. März, Seite 330-342 |
| Sprache: |
Englisch |
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| Weiterer Titel: |
Copeptine périopératoire : valeur prédictive et stratification du risque chez les patient·es bénéficiant d’une chirurgie non cardiaque majeure – une étude de cohorte observationnelle prospective |
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| Beteiligte Personen: |
Kamber, Firmin [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 11.03.2024 Date Revised 12.03.2024 published: Print-Electronic ClinicalTrials.gov: NCT02687776 Citation Status MEDLINE |
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| doi: |
10.1007/s12630-023-02677-y |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367335867 |
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| 245 | 1 | 0 | |a Perioperative copeptin |b predictive value and risk stratification in patients undergoing major noncardiac surgery-a prospective observational cohort study |
| 246 | 3 | 3 | |a Copeptine périopératoire : valeur prédictive et stratification du risque chez les patient·es bénéficiant d’une chirurgie non cardiaque majeure – une étude de cohorte observationnelle prospective |
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| 500 | |a Date Completed 11.03.2024 | ||
| 500 | |a Date Revised 12.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT02687776 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024. The Author(s). | ||
| 520 | |a PURPOSE: Biomarkers can aid in perioperative risk stratification. While preoperative copeptin has been associated with adverse events, intraoperative information is lacking and this association may rather reflect a baseline risk. Knowledge about correlations between postoperative copeptin measurements and clinically relevant outcomes is scarce. We examined the association of perioperative copeptin concentrations with postoperative all-cause mortality and/or major adverse cardiac and cerebrovascular events (MACCE) at 12 months and 30 days as well as with perioperative myocardial injury (PMI) | ||
| 520 | |a METHODS: We conducted a prospective observational cohort study of adults undergoing noncardiac surgery with intermediate to high surgical risk in Basel, Switzerland, and Düsseldorf, Germany from February 2016 to December 2020. We measured copeptin and cardiac troponin before surgery, immediately after surgery (0 hr) and once between the second and fourth postoperative day (POD 2-4) | ||
| 520 | |a RESULTS: A primary outcome event of a composite of all-cause mortality and/or MACCE at 12 months occurred in 48/502 patients (9.6%). Elevated preoperative copeptin (> 14 pmol·L-1), immediate postoperative copeptin (> 90 pmol·L-1), and copeptin on POD 2-4 (> 14 pmol·L-1) were associated with lower one-year MACCE-free and/or mortality-free survival (hazard ratio [HR], 2.89; 95% confidence interval [CI], 1.62 to 5.2; HR, 2.07; 95% CI, 1.17 to 3.66; and HR, 2.47; 95% CI, 1.36 to 4.46, respectively). Multivariable analysis continued to show an association for preoperative and postoperative copeptin on POD 2-4. Furthermore, elevated copeptin on POD 2-4 showed an association with 30-day MACCE-free survival (HR, 2.15; 95% CI, 1.18 to 3.91). A total of 64 of 489 patients showed PMI (13.1%). Elevated preoperative copeptin was not associated with PMI, while immediate postoperative copeptin was modestly associated with PMI | ||
| 520 | |a CONCLUSION: The results of the present prospective observational cohort study suggest that perioperative copeptin concentrations can help identify patients at risk for all-cause mortality and/or MACCE. Other identified risk factors were revised cardiac risk index, body mass index, surgical risk, and preoperative hemoglobin | ||
| 520 | |a TRIAL REGISTRATION: ClinicalTrials.gov (NCT02687776); first submitted 9 February 2016 | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a major cardiovascular and cerebrovascular events (MACCE) | |
| 650 | 4 | |a perioperative copeptin | |
| 650 | 4 | |a perioperative myocardial injury | |
| 650 | 4 | |a perioperative risk stratification | |
| 650 | 7 | |a copeptins |2 NLM | |
| 650 | 7 | |a Glycopeptides |2 NLM | |
| 700 | 1 | |a Roth, Sebastian |e verfasserin |4 aut | |
| 700 | 1 | |a Bolliger, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Seeberger, Esther |e verfasserin |4 aut | |
| 700 | 1 | |a Nienhaus, Johannes |e verfasserin |4 aut | |
| 700 | 1 | |a Mueller, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Lurati Buse, Giovanna |e verfasserin |4 aut | |
| 700 | 1 | |a Mauermann, Eckhard |e verfasserin |4 aut | |
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