European journal of anaesthesiology · 2025
Predictive value of early postoperative copeptin after cardiac surgery: A two-centre prospective cohort study.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Kirkopoulos Anna, Salehi Irsa, M'Pembele René, Maddison Patrick, Stroda Alexandra, Tenge Theresa, Donaldson Daniel, Huhn Ragnar, Kindgen-Milles Detlef, Haddad Ali, Brands Jens, Dubler Simon, Brenner Thorsten, Berger Marc Moritz, Lurati Buse Giovanna, Roth Sebastian
Аннотация
BACKGROUND: Patients undergoing cardiac surgery are at increased risk for postoperative complications, making early postoperative risk evaluation crucial. Recent studies have shown that copeptin, a neurohumoral marker, is associated with major adverse events after noncardiac surgery. However, data on its role after cardiac surgery are scarce.
OBJECTIVE: Primary aim of this study was to analyse the association of early postoperative copeptin levels with adverse events after cardiac surgery.
DESIGN: Observational, prospective cohort study.
SETTING: Two German tertiary healthcare centres. Enrolment took place between March 2021 and August 2022.
PATIENTS: Adults undergoing elective on-pump cardiac surgery were included.
MAIN OUTCOME MEASURES: Main exposure was early postoperative copeptin. Primary outcome was new-onset disability 1 year after surgery, as defined by a World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) score of ≥16% or an increase of ≥5% in case of pre-operative disability.
RESULTS: 295 out of 363 prospectively enrolled patients were included in the final analysis (28.8% female, median [IQR] age 64 years, [56 to 71]. Fifty-four patients (18.3%) developed new-onset disability and 3.4% (10/295) died within 1 year. Logistic regression analysis showed an adjusted odds ratio (aOR) of 2.35 (95% confidence interval, 'CI', 1.17 to 4.72) for the association between elevated copeptin and new-onset disability. The discrimination of copeptin for new-onset disability was weak and did not improve risk stratification when added to the pre-operative EuroSCORE II and postoperative troponin (ROC AUC EuroSCOREII+troponin+copeptin = 0.685, 95% CI 0.61 to 0.76; ROC AUC EuroSCOREII+troponin = 0.678, 95% CI 0.59 to 0.76, DeLong test: P = 0.82). DeLong test: P = 0.82).
CONCLUSION: Early postoperative copeptin is independently associated with new-onset disability at 1 year after cardiac surgery. Due to weak discrimination for new-onset disability routine measurement of copeptin cannot be recommended.
TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04877795.
OBJECTIVE: Primary aim of this study was to analyse the association of early postoperative copeptin levels with adverse events after cardiac surgery.
DESIGN: Observational, prospective cohort study.
SETTING: Two German tertiary healthcare centres. Enrolment took place between March 2021 and August 2022.
PATIENTS: Adults undergoing elective on-pump cardiac surgery were included.
MAIN OUTCOME MEASURES: Main exposure was early postoperative copeptin. Primary outcome was new-onset disability 1 year after surgery, as defined by a World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) score of ≥16% or an increase of ≥5% in case of pre-operative disability.
RESULTS: 295 out of 363 prospectively enrolled patients were included in the final analysis (28.8% female, median [IQR] age 64 years, [56 to 71]. Fifty-four patients (18.3%) developed new-onset disability and 3.4% (10/295) died within 1 year. Logistic regression analysis showed an adjusted odds ratio (aOR) of 2.35 (95% confidence interval, 'CI', 1.17 to 4.72) for the association between elevated copeptin and new-onset disability. The discrimination of copeptin for new-onset disability was weak and did not improve risk stratification when added to the pre-operative EuroSCORE II and postoperative troponin (ROC AUC EuroSCOREII+troponin+copeptin = 0.685, 95% CI 0.61 to 0.76; ROC AUC EuroSCOREII+troponin = 0.678, 95% CI 0.59 to 0.76, DeLong test: P = 0.82). DeLong test: P = 0.82).
CONCLUSION: Early postoperative copeptin is independently associated with new-onset disability at 1 year after cardiac surgery. Due to weak discrimination for new-onset disability routine measurement of copeptin cannot be recommended.
TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04877795.