Carrie A Sims1, Yuxia Guan2, Meredith Bergey3, Rebecca Jaffe2, Lilias Holmes-Maguire2, Niels Martin2, Patrick Reilly2. 1. The Trauma Center at Penn, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA; Penn Acute Research Collaboration, Penn Presbyterian Medical Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: carrie.sims@uphs.upenn.edu. 2. The Trauma Center at Penn, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA. 3. University of Virginia, Department of Sociology, Charlottesville, VA, USA.
Abstract
BACKGROUND: Arginine vasopressin (AVP) is critical for maintaining vasomotor tone and low levels have been associated with the development of irreversible shock. We investigated the clinical relationship between AVP, copeptin (the C-terminal fragment of the AVP precursor), and the development of relative AVP deficiency following hemorrhagic shock. METHODS: A prospective, observational study of 21 hypotensive (SBP<90 mmHg X 2) or presumptively bleeding trauma patients was conducted. Demographics, mechanism of injury, vital signs, laboratory values, transfusions, crystalloid volume, and blood samples were collected on arrival and serially for 48 h. AVP and copeptin were measured post hoc. RESULTS: AVP and copeptin levels were markedly elevated on admission, but decreased rapidly over time (p < 0.001). AVP and copeptin levels were positively correlated on admission (r = 0.769, p < 0.001), in the ICU (r = 0.768, p < 0.001), and at 48 h (r = 0.537, p = 0.02). Initial AVP and copeptin levels predicted the need for ≥10 unit blood product transfusion (AUC = 81% and 87%, respectively). The development of a relative AVP deficiency occurred frequently and was associated with an increased need for blood product transfusion. CONCLUSION: Copeptin correlates well with AVP and initial values predict the need for massive transfusion in trauma patients. Copeptin demonstrates promise as a clinical biomarker in hemorrhagic shock.
BACKGROUND:Arginine vasopressin (AVP) is critical for maintaining vasomotor tone and low levels have been associated with the development of irreversible shock. We investigated the clinical relationship between AVP, copeptin (the C-terminal fragment of the AVP precursor), and the development of relative AVP deficiency following hemorrhagic shock. METHODS: A prospective, observational study of 21 hypotensive (SBP<90 mmHg X 2) or presumptively bleeding traumapatients was conducted. Demographics, mechanism of injury, vital signs, laboratory values, transfusions, crystalloid volume, and blood samples were collected on arrival and serially for 48 h. AVP and copeptin were measured post hoc. RESULTS:AVP and copeptin levels were markedly elevated on admission, but decreased rapidly over time (p < 0.001). AVP and copeptin levels were positively correlated on admission (r = 0.769, p < 0.001), in the ICU (r = 0.768, p < 0.001), and at 48 h (r = 0.537, p = 0.02). Initial AVP and copeptin levels predicted the need for ≥10 unit blood product transfusion (AUC = 81% and 87%, respectively). The development of a relative AVP deficiency occurred frequently and was associated with an increased need for blood product transfusion. CONCLUSION: Copeptin correlates well with AVP and initial values predict the need for massive transfusion in traumapatients. Copeptin demonstrates promise as a clinical biomarker in hemorrhagic shock.
Authors: Carrie A Sims; Daniel Holena; Patrick Kim; Jose Pascual; Brian Smith; Neils Martin; Mark Seamon; Adam Shiroff; Shariq Raza; Lewis Kaplan; Elena Grill; Nicole Zimmerman; Christopher Mason; Benjamin Abella; Patrick Reilly Journal: JAMA Surg Date: 2019-11-01 Impact factor: 14.766
Authors: Carrie A Sims; Guan Yuxia; Khushboo Singh; Evan C Werlin; Patrick M Reilly; Joseph A Baur Journal: PLoS One Date: 2017-10-24 Impact factor: 3.240
Authors: Fulvio Salvo; Francesco Luppi; Davide M Lucchesi; Simone Canovi; Stefano Franchini; Alessandra Polese; Francesca Santi; Laura Trabucco; Tommaso Fasano; Anna Maria Ferrari Journal: BMC Emerg Med Date: 2020-02-24