Copeptin as a marker of outcome after cardiac arrest: a sub-study of the TTM trial
Copeptin as a marker of outcome after cardiac arrest: a sub-study of the TTM trial
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DOI：
10.1186/s13054-020-02904-8
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发表时间：
2020-04-28
期刊：
影响因子：
15.1
通讯作者：
Nielsen, Niklas
中科院分区：
文献类型：
--
作者：
During, Joachim;Annborn, Martin;Nielsen, Niklas
背景精氨酸加压素在危重患者中具有复杂的作用，涉及血管调节状态、血浆容量和皮质醇水平。和肽素是精氨酸加压素的替代标记物，在小型观察性研究中显示出有希望的预后特征，并在临床上用于早期排除急性冠状动脉综合征。本研究的目的是探讨和肽素的早期测量值、循环状态和院外心脏骤停后短期生存率之间的关系。方法在24、48和72 h采集系列血样，作为心脏骤停试验后33 ℃和36 ℃目标温度管理的一部分，这是一项国际多中心随机试验，将院外心脏骤停后无意识的幸存者分配到33或36 ℃的干预24 h。主要结局为30天生存率，次要终点为循环系统死亡原因和心血管恶化复合终点;此外，我们检查了与扩展的心血管序贯器官衰竭评估（eCvSOFA）评分的相关性。结果690例患者中，203例（30.3%）在24 h内发生心血管恶化，273例（39.6%）在30 d内死亡。发现24小时测量的和肽素与30天存活率独立相关，风险比1.17 [1.06-1.28]，p = 0.001;循环系统死亡原因，比值比1.03 [1.01-1.04]，p = 0.001;与心血管恶化复合终点的比值比为1.05 [1.02-1.08]，p < 0.001。24小时的和肽素与eCvSOFA评分相关，rho为0.19 [0.12-0.27]，p < 0.001。结论和肽素是反映心脏骤停后综合征严重程度的独立指标，与循环衰竭部分相关。
Background Arginine vasopressin has complex actions in critically ill patients, involving vasoregulatory status, plasma volume, and cortisol levels. Copeptin, a surrogate marker for arginine vasopressin, has shown promising prognostic features in small observational studies and is used clinically for early rule out of acute coronary syndrome. The objective of this study was to explore the association between early measurements of copeptin, circulatory status, and short-term survival after out-of-hospital cardiac arrest. Methods Serial blood samples were collected at 24, 48, and 72 h as part of the target temperature management at 33 degrees C versus 36 degrees C after cardiac arrest trial, an international multicenter randomized trial where unconscious survivors after out-of-hospital cardiac arrest were allocated to an intervention of 33 or 36 degrees C for 24 h. Primary outcome was 30-day survival with secondary endpoints circulatory cause of death and cardiovascular deterioration composite; in addition, we examined the correlation with extended the cardiovascular sequential organ failure assessment (eCvSOFA) score. Results Six hundred ninety patients were included in the analyses, of whom 203 (30.3%) developed cardiovascular deterioration within 24 h, and 273 (39.6%) died within 30 days. Copeptin measured at 24 h was found to be independently associated with 30-day survival, hazard ratio 1.17 [1.06-1.28], p = 0.001; circulatory cause of death, odds ratio 1.03 [1.01-1.04], p = 0.001; and cardiovascular deterioration composite, odds ratio of 1.05 [1.02-1.08], p < 0.001. Copeptin at 24 h was correlated with eCvSOFA score with rho 0.19 [0.12-0.27], p < 0.001. Conclusion Copeptin is an independent marker of severity of the post cardiac arrest syndrome, partially related to circulatory failure.