Clinical relevance of copeptin plasma levels as a biomarker of disease severity and mortality in critically ill patients

J Clin Lab Anal. 2018 Nov;32(9):e22614. doi: 10.1002/jcla.22614. Epub 2018 Jul 5.


Background: Copeptin, also termed C-terminal pre-pro-vasopressin or CTproAVP, mirrors endogenous vasopressin (anti-diuretic hormone, ADH) activity and might thereby serve as a biomarker reflecting the biological stress level. We therefore hypothesized that copeptin plasma concentrations are associated with disease severity in critically ill patients and could predict mortality.

Methods: We analyzed plasma copeptin levels in a prospective, single-center, observational study comprising 218 critically ill patients at admission to the medical intensive care unit (ICU). Mortality was assessed during a 2-year observational follow-up period.

Results: Copeptin plasma levels were significantly elevated in critically ill patients (n = 218) at ICU admission, as compared with 66 healthy controls. Neither sepsis as the cause of critical illness nor pre-existing metabolic disorders (type 2 diabetes, obesity) were found to influence copeptin levels. On the contrary, plasma copeptin was closely associated with disease severity (eg APACHE-II score) and correlated with biomarkers of inflammation, renal failure, metabolism, vascular tone, and tissue perfusion. Elevated copeptin levels at ICU admission predicted short-term and long-term mortality.

Conclusions: Copeptin plasma concentrations are significantly elevated in critically ill patients, correlate with disease severity and predict ICU and long-term outcome. Thus, copeptin could be a promising tool for prognostication and management of critically ill patients.

Keywords: ICU; C-terminal pre-pro-vasopressin; anti-diuretic hormone; arginine vasopressin; organ failure; prognosis; sepsis; vasopressin.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Critical Illness / mortality*
  • Female
  • Glycopeptides / blood*
  • Humans
  • Intensive Care Units
  • Longitudinal Studies
  • Male
  • Metabolic Diseases / blood
  • Middle Aged
  • Prognosis
  • Renal Insufficiency / blood
  • Retrospective Studies
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Young Adult


  • Biomarkers
  • Glycopeptides
  • copeptins