Circulating levels of copeptin predict outcome in patients with pulmonary arterial hypertensionReportar como inadecuado




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Respiratory Research

, 14:130

First Online: 19 November 2013Received: 24 June 2013Accepted: 16 October 2013

Abstract

ObjectiveTo determine the levels of circulating copeptin in patients with pulmonary arterial hypertension PAH, and to evaluate its relation with disease severity, outcome and response to treatment.

BackgroundVasopressin is a key regulator of body fluid homeostasis. The co-secreted protein copeptin serves as surrogate for plasma vasopressin levels and increases in acute and chronic left ventricular dysfunction. Copeptin has not been studied in PAH.

MethodsSerum copeptin levels were evaluated in a retrospective cohort of 92 treatment-naïve patients with PAH, 39 patients with normal right ventricular hemodynamics diseased controls and 14 apparently healthy individuals healthy controls. In a second prospective cohort of 15 patients with PAH, serial changes of copeptin levels after initiation of PAH treatment were measured. Copeptin levels were compared with clinical, biochemical and hemodynamic parameters as well as response to treatment and clinical outcome.

ResultsCirculating copeptin levels were elevated in PAH patients compared to diseased controls 20.1 pmol-l vs. 5.1 pmol-l; p = 0.001. Baseline levels of copeptin correlated with NYHA functional class r = 0.46; p = 0.01, 6 minute walking distance r = -0.26; p = 0.04, NT-proBNP r = 0.49, p = 0.01, creatinine r = 0.39, p = 0.01 and estimated glomerular filtration rate r = -0.32, p = 0.01. Copeptin levels did not correlate with hemodynamics but decreased after initiation of PAH therapy p = 0.001. Elevated copeptin levels were associated with shorter survival p < 0.001 and independent predictors of mortality in a multiple Cox regression analysis HR1.4; 95% confidence interval 1.1-2.0; p = 0.02.

ConclusionsPatients with PAH had elevated copeptin levels. High circulating levels of copeptin were independent predictors of poor outcome, which makes copeptin a potentially useful biomarker in PAH.

Abbreviations6MWDSix minute walking distance

CICardiac index

eGFREstimated glomerular filtration rate

eGFR-CKD-EPIEstimated glomerular filtration calculated according the chronic Kidney disease epidemiology collaboration formula

mPAPMean Pulmonary Arterial pressure

NT-proBNPN-terminal prohormone of brain natriuretic peptide

NYHANew York Heart Association

PAHPulmonary arterial hypertension

PCWPPulmonary capillary wedge pressure

PVRPulmonary vascular resistance

RARight atrial pressure

S-NaSerum Sodium Concentration

SvO2Mixed venous oxygen saturation.

Electronic supplementary materialThe online version of this article doi:10.1186-1465-9921-14-130 contains supplementary material, which is available to authorized users.

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Autor: Nils P Nickel - Ralf Lichtinghagen - Heiko Golpon - Karen M Olsson - Korbinian Brand - Tobias Welte - Marius M Hoeper

Fuente: https://link.springer.com/







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