Abstract 84: Predictive Value of Plasma Copeptin and Free Cortisol on Admission and at 48 Hours in Patients Resuscitated from Out-of-Hospital Cardiac Arrest
Background: Pilot trials have suggested excellent prognostic value of copeptin, a stress hormone synthesized in the hypothalamus, in patients resuscitated from out-hospital-cardiac arrest (OHCA) (1,2). We studied associations between two stress hormones, copeptin and free cortisol, and long-term outcome in a large prospective observational cohort of OHCA patients.
Materials and Methods: Plasma samples obtained in the prospective observational FINNRESUSCI study conducted in 21 Finnish intensive care units in 2010-2011 (3). We measured Copeptin (lg/ml) and cortisol (mmol/l) with enzyme-linked immunosorbent assays in samples obtained 0-6h from ICU admission and at 48 hours from return of spontaneous circulation (ROSC) in patients in whom informed consent was obtained. Twelve month neurological outcome was classified using the cerebral performance category (CPC) and dichotomized into either good (1-2) or poor (3-5). Data are presented as medians and interquartile ranges (IQR). Mann-Whitney U test, Spearmans correlation test and receiver operating characteristic curves with the area under the curve (AUC) were used. A two-tailed p-value less than 0.05 was considered significant.
Results: A total of 278 patients were included. Plasma samples were available for 248 (89%) on admission and for 227 (81%) at 48h after ROSC. The median delay to ROSC was 20 min (IQR 13-28). The 12-month outcome was good in 48% and poor in 52% of the patients. Copeptin and cortisol levels in plasma were higher in patients with a poor outcome on admission in comparison to those with a good outcome (92 [39-196] vs. 50 [28-109] p=0.001), and (725 [511-1018] vs. 573 [354-852], p=0.002, respectively). The discriminatory power was weak with AUCs of 0.62 (95%CI 0.55-0.69) and 0.62 (95%CI 0.54-0.69) respectively. The corresponding AUCs at 48h were 0.57 (0.49-0.65) and 0.61 (0.53-0.69). There was also a weak correlation between delay to ROSC and ICU admission levels of both copeptin (r=0.23), and cortisol (r=0.121).
Conclusion: In this large sample of OHCA patients neither plasma copeptin nor free cortisol correlated well with time to ROSC and did not appear to be of prognostic value regarding the prediction of 12-month neurological outcome.
Author Disclosures: M.B. Skrifvars: None. G. Ristagno: None. R. Latini: None. M. Plebani: None. M. Zaninotto: None. J. Vaahersalo: None. S. Masson: None. M. Tiainen: None. J. Kurola: None. F. Gaspari: None. T. Varpula: None. P. Ville: None.
- © 2014 by American Heart Association, Inc.