Copeptin in the assessment of acute lung injury and cardiogenic pulmonary edema

Respir Med. 2012 Sep;106(9):1268-77. doi: 10.1016/j.rmed.2012.05.010. Epub 2012 Jun 22.


Backgrounds: Copeptin has been studied as an excellent predictor of outcome in a variety of diseases, its value is even superior to that of B-type natriuretic peptide (BNP) in heart failure, but little is known about its characteristics in acute respiratory distress syndrome (ARDS)/acute lung injury (ALI). We sought to assess the diagnostic and prognostic value of copeptin together with N-terminal pro-BNP (NT-proBNP) in patients with ARDS/ALI or cardiogenic pulmonary edema (CPE).

Methods: Measurement of copeptin and NT-proBNP levels in plasma from 121 consecutive patients with either ARDS/ALI or CPE enrolled in a prospective single center study.

Results: In a derivation cohort of 87 patients with ARDS/ALI and 34 patients with CPE, a copeptin threshold of >40.11 pmol/L provided a specificity of 88.2% and a sensitivity of 60.9% for the diagnosis of ARDS/ALI, a NT-proBNP cut point of <2813 pg/ml had a specificity of 79.4% and sensitivity of 65.5% for it. Multivariate Cox regression analysis showed that copeptin was the strongest predictor for mortality in patients with ARDS/ALI [hazard ratio (HR) = 4.72, P < 0.001] and CPE (HR = 3.52, P = 0.019), the association between increasing copeptin and death was statistically significant in patients with ARDS/ALI (HR = 2.64, P = 0.035) and patients with CPE (HR = 1.62, P = 0.029).

Conclusion: Copeptin of >40.11 pmol/L had a high specificity for the diagnosis of ARDS/ALI in patients presenting with ARDS/ALI or CPE. Compared to NT-proBNP, copeptin was a stronger prognostic marker for short-term mortality.

MeSH terms

  • Acute Lung Injury / diagnosis*
  • Acute Lung Injury / mortality
  • Aged
  • Cardiomyopathy, Dilated / complications
  • Cardiomyopathy, Dilated / diagnosis
  • Cardiomyopathy, Dilated / mortality
  • Female
  • Glycopeptides / metabolism*
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / metabolism
  • Peptide Fragments / metabolism
  • Prognosis
  • Prospective Studies
  • Pulmonary Edema / diagnosis*
  • Pulmonary Edema / etiology
  • Pulmonary Edema / mortality
  • ROC Curve
  • Respiratory Distress Syndrome / diagnosis
  • Respiratory Distress Syndrome / mortality
  • Ventricular Dysfunction, Left / complications
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / mortality


  • Glycopeptides
  • Peptide Fragments
  • copeptins
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain