Copeptin, C-reactive protein, and procalcitonin as prognostic biomarkers in acute exacerbation of COPD

• Published in: Chest Vol. 131; no. 4; p. 1058
• Main Authors: Stolz, Daiana, Christ-Crain, Mirjam, Morgenthaler, Nils G, Leuppi, Jörg, Miedinger, David, Bingisser, Roland, Müller, Christian, Struck, Joachim, Müller, Beat, Tamm, Michael
• Format: Journal Article
• Language: English
• Published: United States 01.04.2007
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers - blood; C-Reactive Protein - metabolism; Calcitonin - blood; Calcitonin Gene-Related Peptide; Female; Follow-Up Studies; Glycopeptides - blood; Glycoproteins; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Prognosis; Protein Precursors - blood; Pulmonary Disease, Chronic Obstructive - blood; Recurrence; Retrospective Studies; Time Factors
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.06-2336

A novel approach to estimate the severity of COPD exacerbation and predict its outcome is the use of biomarkers. We assessed circulating levels of copeptin, the precursor of vasopressin, C-reactive protein (CRP), and procalcitonin as potential prognostic parameters for in-hospital and long-term outcomes in patients with acute exacerbation of COPD (AECOPD) requiring hospitalization. Data of 167 patients (mean age, 70 years; mean FEV(1), 39.9 +/- 16.9 of predicted [+/- SD]) presenting to the emergency department due to AECOPD were analyzed. Patients were evaluated based on clinical, laboratory, and lung function parameters on hospital admission, at 14 days, and at 6 months. Plasma levels of all three biomarkers were elevated during the acute exacerbation (p < 0.001), but levels at 14 days and 6 months were similar (p = not significant). CRP was significantly higher in patients presenting with Anthonisen type I exacerbation (p = 0.003). In contrast to CRP and procalcitonin, copeptin on hospital admission was associated with a prolonged hospital stay (p = 0.002) and long-term clinical failure (p < 0.0001). Only copeptin was predictive for long-term clinical failure independent of age, comorbidity, hypoxemia, and lung functional impairment in multivariate analysis (p = 0.005). The combination of copeptin and previous hospitalization for COPD increased the risk of poor outcome (p < 0.0001). Long-term clinical failure was observed in 11% of cases with copeptin < 40 pmol/L and no history of hospitalization, as compared to 73% of patients with copeptin >/= 40 pmol/L and a history of hospitalization (p < 0.0001). We suggest copeptin as a prognostic marker for short-term and long-term prognoses in patients with AECOPD requiring hospitalization.