Objective
The aim of this study was to evaluate copeptin as a predictor of short-term ICU mortality in patients with sepsis and its relation with disease severity.
Design
This study was an observational case–control one.
Methods
The study included 60 patients admitted to the ICU with sepsis: 20 patients with sepsis, 20 patients with severe sepsis, and 20 patients with septic shock. Baseline characteristics, serum copeptin, and APACHE II score were determined at the time of admission. They were prospectively followed up for 7 days to determine improvement, development of multiple organ failure, or death. Copeptin level in patients with sepsis was compared with its level in the control group comprising 10 patients with congestive heart failure, 10 patients with post-acute myocardial infarction, and 10 healthy individuals.
Results
The mean copeptin level was 48.4 (15.1) pmol/l in patients with sepsis, 69.2 (15.4) pmol/l in severe sepsis, and 120.9 (31.2) pmol/l in septic shock. It was significantly higher than its level in post-acute myocardial infarction [21.1 (8.0) pmol/l], congestive heart failure [20.6 (9.8) pmol/l], and healthy controls [8 (4.3) pmol/l] (<0.001). Spearman correlation analysis showed a positive correlation between copeptin and total leukocytic count (=0.466; <0.001), urea (=0.496; <0.001), creatinine (=0.552; <0.001), alanine aminotransferase (=0.451; <0.001), and APACHII (=0.661; <0.001). Improved patients significantly had lower copeptin [43.5 (8.7) pmol/l] than those who died [103.8 (36.2) pmol/l] (<0.001). Area under the curve of copeptin for predicting mortality was 0.880 (<0.001). A cutoff value of 58.1 pmol/l had 96.6% sensitivity and 61.3% specificity.
Conclusion
Serum copeptin is a sensitive predictor of mortality in critically ill patients with sepsis. Moreover, it could be a promising biomarker for disease severity and development of multiple organ failure in this group of patients.