Usefulness of Copeptin for Predicting Long-term Clinical Outcomes in Patients with Heart Failure

Background: Copeptin, a surrogate marker of proarginine vasopression, is expected to be a useful marker for diagnosis and predicting clinical outcomes in cardiovascular disease. However, its usefulness in patients with heart failure (HF) has not been adequately evaluated yet in real-world clinical practice. Methods and Results: In consecutive 107 patients hospitalized for HF in Kyoto University Hospital between April 2011 and July 2012, median serum copeptin level on admission was 15.5 (6.7–32.0) pmol/L. As compared with the low-copeptin group (<18 pmol/L, N = 60), the high-copeptin group (≧18 pmol/L, N = 47) included more male patients and those with prior myocardial infarction, prior HF, low ejection fraction and chronic kidney disease. During median 4.5 (1.0–5.5) years clinical follow-up, the cumulative incidence of a composite of all-cause death and HF re-admission (all-cause death/re-admission for HF) was significantly higher in the high-copeptin group than in the low-copeptin group (63.4% versus 33.0% at 1 year, 77.1% versus 62.2% at 3 years, and 85.2% versus 77.2% at 5 years, respectively, log-rank P = .03). After adjustment for confounders, the higher-copeptin level was still an independent predictor for all-cause death/re-admission for HF (hazard ratio [95% confidence interval]: 1.77 [1.04–3.01], P = .03). Conclusion: Copeptin was suggested to be a potential useful marker for predicting long-term clinical outcomes in patients with HF.