Copeptin as a marker of relative arginine vasopressin deficiency after pediatric cardiac surgery
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Relative arginine vasopressin (AVP) deficiency after pediatric cardiac surgery has recently been described. Copeptin, a more stable and easily measured product of pro-AVP processing, may be a means of identifying these patients. We aimed to determine if copeptin was correlated with AVP in these children and whether it can be a surrogate marker of relative AVP deficiency.
Patients <6 years of age with basic Aristotle scores ≥7 requiring surgery with cardiopulmonary bypass were prospectively enrolled. Plasma AVP and copeptin concentrations were measured pre-cardiopulmonary bypass and 4 and 24 h post-cardiopulmonary bypass. Relative AVP deficiency was defined a priori based on our previous work as AVP <9.2 pg/ml at 4 h post-cardiopulmonary bypass.
Of 41 children enrolled, relative AVP deficiency was present in 13 (32 %). AVP and copeptin concentrations were significantly lower in these 13 children at 4 h post-cardiopulmonary bypass as compared to the other 28 patients. A significant positive association between plasma AVP and copeptin concentrations over time was determined. Based on log-transformed analyses, a 1 % increase in plasma AVP led to a 0.19 % increase in copeptin. Further, copeptin <1.12 ng/ml at 4 h post-cardiopulmonary bypass had a sensitivity of 92 % and a negative predictive value of 95 % for relative AVP deficiency.
Plasma AVP and copeptin are positively associated in children undergoing cardiac surgery. Copeptin may represent a useful means of identifying relative AVP deficiency in these patients.
KeywordsArginine vasopressin Copeptin Pediatrics Cardiopulmonary bypass Cardiac surgical procedures Postoperative care
We acknowledge funding for this study from the Children’s Research Center of Michigan, Heart of a Child Foundation in Michigan, and a Merit Review Award by the Department of Veterans Affairs to N.F. Rossi. None of these funding sources had any role in the design; collection, analysis, and interpretation of data; writing of the manuscript; or decision to submit the manuscript for publication. We would also like to acknowledge the following: Nurse Clinicians Janet McGivern and Lori Martlock, and Nurse Practitioners Kristen Richards and Michele Dokas with enrollment; Perfusionists Grant Whittlesey and Doug Martin with preoperative blood collection; and Nurse Practitioners Lauren Kelm and Mary Caverly, and Pediatric ICU fellows Angela Mata, Suwannee Phumeetham, Hitesh Sandhu, Rekha Solomon, Monica Chauhan, and Keshava Narayanagowda with postoperative blood collection; and post-doctoral fellow Haiping Chen, who performed the vasopressin assays.
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