• Critical care medicine · Feb 2015

    Is Copeptin Level Associated With 1-Year Mortality After Out-of-Hospital Cardiac Arrest? Insights From the Paris Registry*.

    • Guillaume Geri, Florence Dumas, Camille Chenevier-Gobeaux, Adrien Bouglé, Fabrice Daviaud, Tristan Morichau-Beauchant, Xavier Jouven, Jean-Paul Mira, Frédéric Pène, Jean-Philippe Empana, and Alain Cariou.
    • 1Medical Intensive Care Unit, Cochin Hospital, APHP, Paris, France. 2Paris Descartes University, Sorbonne Paris Cité, Paris, France. 3Sudden Death Expertise Centre, INSERM U970, Paris Cardiovascular Research Center, Paris, France. 4Emergency Department, Cochin Hospital, APHP, Paris, France. 5Department of Automated Biological Diagnosis, Cochin Hospital, APHP, Paris, France.
    • Crit. Care Med.. 2015 Feb 1;43(2):422-9.

    ObjectivesThe availability of circulating biomarkers that helps to identify early out-of-hospital cardiac arrest survivors who are at increased risk of long-term mortality remains challenging. Our aim was to prospectively study the association between copeptin and 1-year mortality in patients with out-of-hospital cardiac arrest admitted in a tertiary cardiac arrest center.DesignRetrospective monocenter study.SettingTertiary cardiac arrest center in Paris, France.PatientsCopeptin was assessed at admission and day 3. Pre- and intrahospital factors associated with 1-year mortality were analyzed by multivariate Cox proportional analysis.InterventionsNone.Measurements And Main ResultsTwo hundred ninety-eight consecutive out-of-hospital cardiac arrest patients (70.3% male; median age, 60.2 yr [49.9-71.4]) were admitted in a tertiary cardiac arrest center in Paris (France). After multivariate analysis, higher admission copeptin was associated with 1-year mortality with a threshold effect (hazard ratio(5th vs 1st quintile) = 1.64; 95% CI, 1.05-2.58; p = 0.03). Day 3 copeptin was associated with 1-year mortality in a dose-dependent manner (hazard ratio(2nd vs 1st quintile) = 1.87; 95% CI, 1.00-3.49; p = 0.05; hazard ratio(3rd vs 1st quintile) = 1.92; 95% CI, 1.02-3.64; p = 0.04; hazard ratio(4th vs 1st quintile) = 2.12; 95% CI, 1.14-3.93; p = 0.02; and hazard ratio(5th vs 1st quintile) = 2.75; 95% CI, 1.47-5.15; p < 0.01; p for trend < 0.01). For both admission and day 3 copeptin, association with 1-year mortality existed for out-of-hospital cardiac arrest of cardiac origin only (p for interaction = 0.05 and < 0.01, respectively). When admission and day 3 copeptin were mutually adjusted, only day 3 copeptin remained associated with 1-year mortality in a dose-dependent manner (p for trend = 0.01).ConclusionHigh levels of copeptin were associated with 1-year mortality independently from prehospital and intrahospital risk factors, especially in out-of-hospital cardiac arrest of cardiac origin. Day 3 copeptin was superior to admission copeptin: this could permit identification of out-of-hospital cardiac arrest survivors at increased risk of mortality and allow for close observation of such patients.

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