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The vasopressin and copeptin response in patients with vasodilatory shock after cardiac surgery: a prospective, controlled study

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Abstract

Objective

To evaluate arginine vasopressin (AVP) and copeptin plasma concentrations in patients with vasodilatory shock after cardiac surgery.

Design

Prospective, controlled, clinical study.

Setting

Surgical intensive care unit and cardiac surgery ward in a tertiary university teaching hospital.

Patients and participants

Thirty-three critically ill patients with vasodilatory shock after cardiac surgery and ten control patients undergoing uncomplicated aorto-coronary bypass surgery.

Measurements and results

Hemodynamic, laboratory and clinical data were recorded daily in all patients during the first 7 days after cardiac surgery. At the same time, points blood was withdrawn to determine plasma concentrations of AVP (radioimmunoassay) and copeptin (immunoluminometric assy). Standard tests, a mixed effects model and regression analyses were used for statistical analysis. The course of AVP was significantly different between groups (P  < 0.001). While AVP concentrations were lower in the study group on the first postoperative day, they were higher than that in the control group from postoperative day 3 on. There was no difference in the postoperative AVP response between study patients with or without chronic angiotensin-converting enzyme inhibitor therapy. Except during continuous veno-venous hemofiltration, AVP and copeptin correlated significantly with each other (P  < 0.001; r = 0.749).

Conclusions

The AVP response to cardiac surgery is significantly different between patients with vasodilatory shock and patients undergoing uncomplicated aorto-coronary bypass surgery. Although no causative relationship between AVP concentrations and cardiovascular instability can be drawn from these results, our data support the hypothesis that inadequately low AVP plasma levels contribute to the failure to restore vascular tone in vasodilatory shock after cardiac surgery.

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Acknowledgments

Supported by the Austrian National Bank, Science Project No. 11343, Vienna, Austria. Nils G. Morgenthaler works at the Department of Research of the B.R.A.H.M.S. company, which has developed and patented the copeptin assay. No other author has a conflict of interest in regards of drugs or assays discussed in this manuscript.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Stefan Jochberger, Corinna Velik-Salchner, Viktoria D. Mayr, Günter Luckner, Volker Wenzel & Martin W. Dünser

  2. Institute for Medical and Chemical Laboratory Diagnostics, Innsbruck Medical University, Innsbruck, Austria

    Gerda Falkensammer

  3. Department of Medical Statistics, Informatics and Health Economics (MSIG), Innsbruck Medical University, Innsbruck, Austria

    Hanno Ulmer

  4. Department of Research, B.R.A.H.M.S. Aktiengesellschaft, Hennigsdorf, Germany

    Nils Morgenthaler

  5. Department of Anesthesiology and Critical Care Medicine, Krankenhaus der Barmherzigen Schwestern, Ried im Innkreis, Austria

    Walter Hasibeder

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  1. Stefan Jochberger
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  2. Corinna Velik-Salchner
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  3. Viktoria D. Mayr
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  4. Günter Luckner
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  7. Hanno Ulmer
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  8. Nils Morgenthaler
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  9. Walter Hasibeder
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  10. Martin W. Dünser
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Correspondence to Stefan Jochberger.

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Jochberger, S., Velik-Salchner, C., Mayr, V.D. et al. The vasopressin and copeptin response in patients with vasodilatory shock after cardiac surgery: a prospective, controlled study. Intensive Care Med 35, 489–497 (2009). https://doi.org/10.1007/s00134-008-1279-1

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  • DOI: https://doi.org/10.1007/s00134-008-1279-1

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