Plasma Copeptin as a Prognostic Marker in Children with Heart Failure.

Objective: To investigate the role of plasma copeptin in predicting mortality in children with heart failure (HF) in addition to poor outcomes, including sepsis, multiorgan dysfunction syndrome, need for mechanical ventilation, and duration of stay in the pediatric intensive care unit.

Methods: This diagnostic study included 76 children aged 1 month to 16 years who were hospitalized with congenital or acquired heart disease with HF, and an age- and gender-matched control group of 65 healthy children. Plasma copeptin level was evaluated within 24 hours of admission. Patient with HF were classified into quartiles according to copeptin levels.

Results: The median plasma copeptin level (pmol/L) was significantly higher in children with HF compared to the healthy children (16.8 vs 8.0; P = 0.001). Patients were classified into quartiles according to their plasma copeptin level as follows; Q1, plasma copeptin level < 7.60 pmol/L; Q2, plasma copeptin level 7.60-10.75 pmol/L; Q3, plasma copeptin level 10.76-17.70 pmol/L; Q4, plasma copeptin level >17.70 pmol/L. The Pediatric Risk of Mortality III (PRISM III) score and inotropic scores were significantly different among the quartiles of copeptin levels in HF (P = 0.001 and 0.003, respectively). A higher proportion of patients who developed sepsis and MODS were in the fourth quartile (P = 0.001 and 0.022, respectively). All mechanically ventilated children were also in the fourth quartile. Plasma copeptin level of 35.5 pmol/L had a sensitivity of 72% and a specificity of 92.5% to predict mortality in children with HF (AUC = 0.72, P = 0.046).

Conclusion: Plasma copeptin is a novel biomarker for the early prediction of mortality and poor outcomes in children with HF.