Kamber F, et al. - Researchers evaluated the time course of peri-operative copeptin and find when concentrations returned to pre-operative levels in adults undergoing vascular surgery. They also performed an explorative analysis to assess the correlation between copeptin in general and at various time points and myocardial injury occurring within the first 48 hours. Findings suggested a large increase in conception concentrations following vascular surgery that endured until the second postoperative day. In patients who ultimately display myocardial injury, postoperative copeptin concentrations seem higher. Identifying those at risk of myocardial injury could be possible via immediate postoperative copeptin concentrations.

Methods

• Experts conducted a preparatory analysis of a prospective, observational cohort study at a single university center from February to July 2016.
• They included a total of 30 consecutive adults undergoing vascular surgery.
• Interventions included were serial peri-operative copeptin measurements.
• They measured copeptin concentrations before and immediately after surgery (0 hours), then at 2, 4, 6 and 8 hours after surgery, and on the first and second postoperative day.
• Authors compared the postoperative concentrations with pre-operative levels via a Wilcoxon signed-rank test.
• An association between postoperative copeptin concentrations and myocardial injury by the second postoperative day was assessed.
• They defined the myocardial injury as a 5 ng l^-1 increase between pre-operative and postoperative high-sensitivity cardiac troponin T with an absolute peak of at least 20 ng l^-1.

Results

• As per data, immediate postoperative copeptin concentrations (median [interquartile range]) increased nearly eight-fold from pre-operative values (8.5 [3.6 to 13.8] to 64.75 pmol l^-1 [29.6 to 258.7];P < 0.001).
• Findings suggested that, until returning to baseline on the second postoperative day, copeptin concentrations stayed elevated.
• Patients experiencing myocardial injury had significantly higher postoperative copeptin vs those who did not (P=0.02).
• Results demonstrated that the earliest most promising single time point for diagnosis might be immediately after surgery (0 hours).
• For immediate postoperative copeptin and myocardial injury by the second postoperative day, the receiver-operating characteristics curve of 0.743 was demonstrated (95% confidence interval 0.560 to 0.926).