PT - JOURNAL ARTICLE AU - Kristian Hellenkamp AU - Piotr Pruszczyk AU - David Jiménez AU - Anna Wyzgał AU - Deisy Barrios AU - Michał Ciurzyński AU - Raquel Morillo AU - Lukas Hobohm AU - Karsten Keller AU - Katarzyna Kurnicka AU - Maciej Kostrubiec AU - Rolf Wachter AU - Gerd Hasenfuß AU - Stavros Konstantinides AU - Mareike Lankeit TI - Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study AID - 10.1183/13993003.02037-2017 DP - 2018 Apr 01 TA - European Respiratory Journal PG - 1702037 VI - 51 IP - 4 4099 - http://erj.ersjournals.com/content/51/4/1702037.short 4100 - http://erj.ersjournals.com/content/51/4/1702037.full SO - Eur Respir J2018 Apr 01; 51 AB - To externally validate the prognostic impact of copeptin, either alone or integrated in risk stratification models, in pulmonary embolism (PE), we performed a post hoc analysis of 843 normotensive PE patients prospectively included in three European cohorts.Within the first 30 days, 21 patients (2.5%, 95% CI 1.5–3.8) had an adverse outcome and 12 (1.4%, 95% CI 0.7–2.5) died due to PE. Patients with copeptin ≥24 pmol·L−1 had a 6.3-fold increased risk for an adverse outcome (95% CI 2.6–15.5, p<0.001) and a 7.6-fold increased risk for PE-related death (95% CI 2.3–25.6, p=0.001). Risk classification according to the 2014 European Society of Cardiology (ESC) guideline algorithm identified 248 intermediate-high-risk patients (29.4%) with 5.6% (95% CI 3.1–9.3) at risk of adverse outcomes. A stepwise biomarker-based risk assessment strategy (based on high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and copeptin) identified 123 intermediate-high-risk patients (14.6%) with 8.9% (95% CI 4.5–15.4) at risk of adverse outcomes. The identification of patients at higher risk was even better when copeptin was measured on top of the 2014 ESC algorithm in intermediate-high-risk patients (adverse outcome OR 11.1, 95% CI 4.6–27.1, p<0.001; and PE-related death OR 13.5, 95% CI 4.2–43.6, p<0.001; highest risk group versus all other risk groups). This identified 85 patients (10.1%) with 12.9% (95% CI 6.6–22.0) at risk of adverse outcomes and 8.2% (95% CI 3.4–16.2) at risk of PE-related deaths.Copeptin improves risk stratification of normotensive PE patients, especially when identifying patients with an increased risk of an adverse outcome.Copeptin improves risk stratification of normotensive patients with pulmonary embolism http://ow.ly/8E3P30jtvym