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research letter

Indian Pediatr 2015;52: 807-808

Serum Copeptin Level as a Predictor of Outcome in Pneumonia

 

Mohammed Abdel-Fattah, *Bassant Meligy, #Riham El-Sayed and Yosra A El-Naga

From Departments of Pediatrics and #Clinical and Chemical Pathology; Faculty of Medicine, Cairo University, Egypt.
*Email: [email protected] 

  


This cross-sectional study included 41 children (age 2 mo-12 y) with pneumonia and 40 healthy controls. Assay of serum copeptin was done using ELISA. Median serum copeptin levels were significantly higher (P=0.03) in children with pneumonia, and in those who died (P=0.04). We conclude that serum copeptin levels seem to be associated with poor outcome in pneumonia.

Keywords: Copeptin, Pneumonia, Prognosis.



Pneumonia is one of the important causes of morbidity and mortality in under-five children [1]. Vasopressin is derived from a larger precursor peptide (pre-provasopressin), and is released together with copeptin in equimolar ratio to vasopressin mirroring its levels, and is more stable to measure in the circulation [2]. An increment in copeptin level with the severity of sepsis, and it being an independent predictor of mortality in pneumonia has been reported in adults [3,4]. This study aimed to assess the diagnostic and prognostic significance of copeptin levels in pediatric pneumonia.

This case-control study was conducted at Faculty of Medicine, Cairo University, Egypt, from January 2013 to December 2013. It included 41 children (2 months to 12 years) with a diagnosis of community-acquired pneumonia (WHO definition of pneumonia and having X-ray findings), or ventilator-associated pneumonia (pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation with Clinical Pulmonary Infections Score (CPIS) [5] above six). Patients who had been hospitalized and treated with antibiotics for ³48 hours, and those having dehydration, immunodeficiency or malignancy, were excluded. Forty healthy matched children were included as controls. Serum copeptin was assayed by a commercial ELISA kit (sensitivity 1.0 pg/mL). A written informed consent was obtained from parents before enrolment. Statistical analysis was performed using Minitab 17. Receiver operating characteristic (ROC) curve was plotted to estimate predictive capability of copeptin for disease. P value <0.05 was considered statistically significant.

The study included 29 children with community acquired pneumonia (CAP) and 12 children with ventilator-associated pneumonia (VAP). Thirteen children with pneumonia died. Median copeptin levels were significantly higher in patients compared to controls (31.2 vs. 25.3 pg/mL; P=0.03). Median copeptin levels were significantly higher in children who died as compared to survivors (89.5 vs. 28.1 pg/mL; P=0.04). There were no significant differences in median copeptin levels between CAP and VAP patients (31.2 vs. 30.6 pg/mL; P=0.81). On logistic regression analysis, mechanical ventilation was the only independent variable associated with high odds of mortality (OR 10.0; 95% CI 2.1, 47.0). High (>56 pg/mL) copeptin level was not an independent predictor of mortality (OR 2.4; 95% CI 0.6, 9.4). ROC curve (Fig. 1) showed area under curve (AUC) of 0.62, with copeptin cut-off point of 56 pg/mL having sensitivity and specificity of 39% and 85%, respectively, for diagnosis of pneumonia.

Fig. 1 Receiver operating characteristics (ROC) of serum copeptin levels for diagnosis of pneumonia.

The present study detected elevated copeptin in children with pneumonia, with significantly higher levels in non-survivors compared to survivors. However, high copeptin level was not an independent predictor for mortality. Copeptin showed low sensitivity but high specificity for diagnosis of pneumonia.

Our findings are comparable to previously published literature reporting serum concentrations of copeptin to be significantly higher in patients with CAP or VAP, and their complications [6-9]. The limitations of present study are small sample size and lack of work-up for viral and bacterial pneumonias. We conclude that circulating levels of copeptin are significantly increased in children with pneumonia, and are higher in children dying of the disease. Copeptin levels might predict unfavourable outcome in pediatric pneumonia.

Contributors: All authors have contributed, designed and approved the study.

Funding: None; Competing interest: None stated.

References

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9. Krüger S, Ewig S, Kunde J, Hanschmann A, Marre R, Suttorp N, et al. CAPNETZ Study Group. C-terminal provasopressin (copeptin) in patients with community-acquired pneumonia—influence of antibiotic pre-treatment: results from the German competence network CAPNETZ. J Antimicrob Chemother. 2009;64:159-62.

 

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