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Copeptin concentration in cord blood in infants with early-onset sepsis, chorioamnionitis and perinatal asphyxia.

Schlapbach LJ, Frey S, Bigler S, Manh-Nhi C, Aebi C, Nelle M, Nuoffer JM - BMC Pediatr (2011)

Bottom Line: The highest copeptin concentrations were found in neonates with asphyxia (median 993 pmol/l).Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery.In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Bern, Switzerland. luregn.schlapbach@gmail.com

ABSTRACT

Background: Vasopressin is one of the most important physiological stress and shock hormones. Copeptin, a stable vasopressin precursor, is a promising sepsis marker in adults. In contrast, its involvement in neonatal diseases remains unknown. The aim of this study was to establish copeptin concentrations in neonates of different stress states such as sepsis, chorioamnionitis and asphyxia.

Methods: Copeptin cord blood concentration was determined using the BRAHMS kryptor assay. Neonates with early-onset sepsis (EOS, n = 30), chorioamnionitis (n = 33) and asphyxia (n = 25) were compared to a control group of preterm and term (n = 155) neonates.

Results: Median copeptin concentration in cord blood was 36 pmol/l ranging from undetectable to 5498 pmol/l (IQR 7 - 419). Copeptin cord blood concentrations were non-normally distributed and increased with gestational age (p < 0.0001). Neonates born after vaginal compared to cesarean delivery had elevated copeptin levels (p < 0.0001). Copeptin correlated strongly with umbilical artery pH (Spearman's Rho -0.50, p < 0.0001), umbilical artery base excess (Rho -0.67, p < 0.0001) and with lactate at NICU admission (Rho 0.54, p < 0.0001). No difference was found when comparing copeptin cord blood concentrations between neonates with EOS and controls (multivariate p = 0.30). The highest copeptin concentrations were found in neonates with asphyxia (median 993 pmol/l). Receiver-operating-characteristic curve analysis showed that copeptin cord blood concentrations were strongly associated with asphyxia: the area under the curve resulted at 0.91 (95%-CI 0.87-0.96, p < 0.0001). A cut-off of 400 pmol/l had a sensitivity of 92% and a specifity of 82% for asphyxia as defined in this study.

Conclusions: Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery. In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.

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Related in: MedlinePlus

Copeptin concentration and early-onset sepsis. Copeptin cord blood concentrations in neonates with early-onset sepsis (EOS) and chorioamnnionitis compared with controls. The medians are shown. The dotted line indicates the detection limit (4.8 pmol/l).
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Figure 4: Copeptin concentration and early-onset sepsis. Copeptin cord blood concentrations in neonates with early-onset sepsis (EOS) and chorioamnnionitis compared with controls. The medians are shown. The dotted line indicates the detection limit (4.8 pmol/l).

Mentions: Median copeptin concentrations were 35 pmol/l (IQR 8 - 212) in the EOS versus 20 pmol/l (IQR 6 - 139) in the chorioamnionitis group versus 21 pmol/l (IQR 5 - 324) in controls, see Figure 4. Although median copeptin concentrations were higher in EOS infants compared to controls, this was not statistically significantly (Mann-Whitney Z -0.58, p = 0.56). This was confirmed by multivariate linear regression analysis adjusted for gestational age, birth weight, SGA, delivery mode and umbilical artery pH (beta coefficient 0.16, 95%-CI -0.14 - 0.45, p = 0.30), Copeptin concentrations did not significantly differ between EOS infants with septic shock or with positive blood cultures compared to the rest of EOS infants (p >0.05). ROC curve analysis confirmed that the performance of copeptin to distinguish EOS from controls was poor (area under the curve, 0.53, 95%-CI 0.44 - 0.63, p = 0.57). No difference was found when comparing copeptin levels between the chorioamnionitis group and controls or between the chorioamnionitis and the EOS group (p >0.1). Copoeptin was not associated with CRP, leukocyte count or left shift (immature by total neutrophil ratio, p >0.05, details not shown).


Copeptin concentration in cord blood in infants with early-onset sepsis, chorioamnionitis and perinatal asphyxia.

Schlapbach LJ, Frey S, Bigler S, Manh-Nhi C, Aebi C, Nelle M, Nuoffer JM - BMC Pediatr (2011)

Copeptin concentration and early-onset sepsis. Copeptin cord blood concentrations in neonates with early-onset sepsis (EOS) and chorioamnnionitis compared with controls. The medians are shown. The dotted line indicates the detection limit (4.8 pmol/l).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3118890&req=5

Figure 4: Copeptin concentration and early-onset sepsis. Copeptin cord blood concentrations in neonates with early-onset sepsis (EOS) and chorioamnnionitis compared with controls. The medians are shown. The dotted line indicates the detection limit (4.8 pmol/l).
Mentions: Median copeptin concentrations were 35 pmol/l (IQR 8 - 212) in the EOS versus 20 pmol/l (IQR 6 - 139) in the chorioamnionitis group versus 21 pmol/l (IQR 5 - 324) in controls, see Figure 4. Although median copeptin concentrations were higher in EOS infants compared to controls, this was not statistically significantly (Mann-Whitney Z -0.58, p = 0.56). This was confirmed by multivariate linear regression analysis adjusted for gestational age, birth weight, SGA, delivery mode and umbilical artery pH (beta coefficient 0.16, 95%-CI -0.14 - 0.45, p = 0.30), Copeptin concentrations did not significantly differ between EOS infants with septic shock or with positive blood cultures compared to the rest of EOS infants (p >0.05). ROC curve analysis confirmed that the performance of copeptin to distinguish EOS from controls was poor (area under the curve, 0.53, 95%-CI 0.44 - 0.63, p = 0.57). No difference was found when comparing copeptin levels between the chorioamnionitis group and controls or between the chorioamnionitis and the EOS group (p >0.1). Copoeptin was not associated with CRP, leukocyte count or left shift (immature by total neutrophil ratio, p >0.05, details not shown).

Bottom Line: The highest copeptin concentrations were found in neonates with asphyxia (median 993 pmol/l).Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery.In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Bern, Switzerland. luregn.schlapbach@gmail.com

ABSTRACT

Background: Vasopressin is one of the most important physiological stress and shock hormones. Copeptin, a stable vasopressin precursor, is a promising sepsis marker in adults. In contrast, its involvement in neonatal diseases remains unknown. The aim of this study was to establish copeptin concentrations in neonates of different stress states such as sepsis, chorioamnionitis and asphyxia.

Methods: Copeptin cord blood concentration was determined using the BRAHMS kryptor assay. Neonates with early-onset sepsis (EOS, n = 30), chorioamnionitis (n = 33) and asphyxia (n = 25) were compared to a control group of preterm and term (n = 155) neonates.

Results: Median copeptin concentration in cord blood was 36 pmol/l ranging from undetectable to 5498 pmol/l (IQR 7 - 419). Copeptin cord blood concentrations were non-normally distributed and increased with gestational age (p < 0.0001). Neonates born after vaginal compared to cesarean delivery had elevated copeptin levels (p < 0.0001). Copeptin correlated strongly with umbilical artery pH (Spearman's Rho -0.50, p < 0.0001), umbilical artery base excess (Rho -0.67, p < 0.0001) and with lactate at NICU admission (Rho 0.54, p < 0.0001). No difference was found when comparing copeptin cord blood concentrations between neonates with EOS and controls (multivariate p = 0.30). The highest copeptin concentrations were found in neonates with asphyxia (median 993 pmol/l). Receiver-operating-characteristic curve analysis showed that copeptin cord blood concentrations were strongly associated with asphyxia: the area under the curve resulted at 0.91 (95%-CI 0.87-0.96, p < 0.0001). A cut-off of 400 pmol/l had a sensitivity of 92% and a specifity of 82% for asphyxia as defined in this study.

Conclusions: Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery. In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.

Show MeSH
Related in: MedlinePlus