Serum Copeptin levels in the emergency department predict major clinical outcomes in adult trauma patients
Open Access
- 24 February 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Emergency Medicine
- Vol. 20 (1), 1-10
- https://doi.org/10.1186/s12873-020-00310-5
Abstract
Early prognostication in trauma patients is challenging, but particularly important. We wanted to explore the ability of copeptin, the C-terminal fragment of arginine vasopressin, to identify major trauma, defined as Injury Severity Score (ISS) > 15, in a heterogeneous cohort of trauma patients and to compare its performances with lactate. We also evaluated copeptin performance in predicting other clinical outcomes: mortality, hospital admission, blood transfusion, emergency surgery, and Intensive Care Unit (ICU) admission. This single center, pragmatic, prospective observational study was conducted at Arcispedale Santa Maria Nuova, a level II trauma center in Reggio Emilia, Italy. Copeptin determination was obtained on Emergency Department (ED) arrival, together with venous lactate. Different outcomes were measured including ISS, Revised Trauma Score (RTS), hospital and ICU admission, blood transfusion, emergency surgery, and mortality. One hundred and twenty five adult trauma patients admitted to the ED between June 2017 and March 2018. Copeptin showed a good ability to identify patients with ISS > 15 (AUC 0.819). Similar good performances were recorded also in predicting other outcomes. Copeptin was significantly superior to lactate in identifying patients with ISS > 15 (P 0.0015), and in predicting hospital admission (P 0.0002) and blood transfusion (P 0.016). Comparable results were observed in a subgroup of patients with RTS 7.84. In a heterogeneous group of trauma patients, a single copeptin determination at the time of ED admission proved to be an accurate biomarker, statistically superior to lactate for the identification of major trauma, hospital admission, and blood transfusion, while no statistical difference was observed for ICU admission and emergency surgery. These results, if confirmed, may support a role for copeptin during early management of trauma patients.Keywords
Funding Information
- Arcispedale Santa Maria Nuova (Not Applicable)
This publication has 38 references indexed in Scilit:
- The Cost Of Overtriage: More Than One-Third Of Low-Risk Injured Patients Were Taken To Major Trauma CentersHealth Affairs, 2013
- Copeptin concentration in cord blood in infants with early-onset sepsis, chorioamnionitis and perinatal asphyxiaBMC Pediatrics, 2011
- Survival Benefit of Transfer to Tertiary Trauma Centers for Major Trauma Patients Initially Presenting to Nontertiary Trauma CentersAcademic Emergency Medicine, 2010
- Vasopressin for Hemorrhagic Shock Management: Revisiting the Potential Value in Civilian and Combat Casualty CareThe Journal of Trauma and Acute Care Surgery, 2010
- The utility of base deficit and arterial lactate in differentiating major from minor injury in trauma patients with normal vital signsResuscitation, 2008
- A National Evaluation of the Effect of Trauma-Center Care on MortalityThe New England Journal of Medicine, 2006
- Arginine vasopressin, but not epinephrine, improves survival in uncontrolled hemorrhagic shock after liver trauma in pigs*Critical Care Medicine, 2003
- A Revision of the Trauma ScoreThe Journal of Trauma and Acute Care Surgery, 1989
- THE INJURY SEVERITY SCOREThe Journal of Trauma and Acute Care Surgery, 1974