Copeptin, a fragment of the vasopressin precursor, as a novel predictor of outcome in heart failure
Copeptin, a fragment of the vasopressin precursor, as a novel predictor of outcome in heart failure
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DOI：
10.1111/j.1365-2362.2006.01724.x
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发表时间：
2006-11-01
影响因子：
5.5
通讯作者：
Pacher, R.
中科院分区：
文献类型：
--
作者：
Stoiser, B.;Moertl, D.;Pacher, R.
背景：心力衰竭时，利钠肽，尤其是脑利钠肽(BNP)升高，因此被认为是良好的预后预测因子。加压素也被认为与心脏病的严重程度有关。Copeptin是加压素前体的一个非活性片段，以前还没有在心力衰竭的背景下进行过研究。材料和方法我们前瞻性地研究了268名出院后的晚期心力衰竭患者。结果在平均15.8个月(长达24个月)的随访期内，83名患者死亡，122名患者心力衰竭恶化，145名患者达到联合终点。死亡的单变量预测因素是铜绿素、脑钠素、年龄和肾功能受损。在多因素分析中，Copeptin(chi(2)=16，P<；0.0001)和年龄(chi(2)=4，P<；0.05)是独立的预测因素。因心力衰竭再住院的单变量预测因素是铜绿素、脑钠素、年龄和肾功能受损。在多因素分析中，脑钠素(chi(2)=18，P<；0.0001)、年龄(chi(2)=11.8，P<；0.001)和Copeptin(chi(2)=4.2P<；0.001)是独立的预测因素。尽管BNP仍适用于预测慢性心力衰竭(CHF)再住院，但在预测死亡和联合终点方面，BNP的价值优于BNP。我们的数据表明，后叶加压素拮抗剂可能是改善这一人群预后的新靶点。
Background Natriuretic peptides, particularly brain natriuretic peptide (BNP), are elevated in heart failure and therefore considered to be excellent predictors of outcome. Vasopressin is also known to be related to the severity of heart disease. Copeptin - an inactive fragment of the vasopressin precursor - has not been previously investigated in the context of heart failure.Materials and methods We prospectively studied 268 patients with advanced heart failure after they had been discharged from the hospital. We investigated the ability of BNP and copeptin to predict death, re-hospitalization due to heart failure, and a combination of the two endpoints.Results Over a mean follow-up period of 15.8 months (up to 24 months), 83 patients died, 122 patients experienced worsening of heart failure, and 145 patients achieved the combined endpoint. Univariate predictors of death were copeptin, BNP, age and impaired kidney function. In multivariate analysis, copeptin (chi(2) = 16, P < 0.0001) and age (chi(2) = 4, P < 0.05) were independent predictors. Univariate predictors of re-hospitalization due to heart failure were copeptin, BNP, age and impaired kidney function. Furthermore, in multivariate analysis BNP (chi(2) = 18, P < 0.0001), age (chi(2) = 11.8, P < 0.001) and copeptin (chi(2) = 4.2, P < 0.05) were found to be independent predictors.Conclusion Our study is the first to show that copeptin is an excellent predictor of outcome in advanced heart failure patients. Its value is superior to that of BNP in predicting death and a combined endpoint, although BNP is still suitable for predicting chronic heart failure (CHF) re-hospitalization. Our data imply that vasopressin antagonism might be a new target to improve outcome in this population.