Full Text Article Open Access

Citation: Gomaa Salah R. Copeptin: A reliable diagnostic and prognostic biomarker or just the stress hormone?.Jr.med.res. 2022;

Submit your manuscript: www.jmedicalresearch.com

Editorial

Copeptin: A reliable diagnostic and prognostic biomarker or just the

stress hormone?

Dr. Randa Salah Gomaa

Department of Medical Physiology, Faculty of Medicine,

Zagazig University, Zagazig, Egypt

Copeptin is an arginine‐vasopressin (AVP) glycopeptide composed of 39 amino acids, and it is derived from the

C‐terminal part of pre‐pro‐AVP (AVP precursor).The AVP precursor molecule is converted into equimolar

amounts of AVP, neurophysiolin II, and copeptin. Copeptin is the biochemical mirror to the AVP. As being

synthesized from the same ancestor, its level is objectively correlated with AVP release [1]. Measurement of

AVP concentration is complicated due to the instability of this peptide and usual platelets bounding. Copeptin

remains stable in the plasma for several days at room temperature. Its testability is effective, and results

may be available within an hour [2]. Previous studies have shown a clear diagnostic predictive value of copeptin

in multiple clinical conditions especially diabetic heart diseases [3,4].

Severe acute respiratory syndrome (SARS) has had a major impact on health systems worldwide with a

considerable mortality rate of ventilated patients specially in COVID-19 pandemic. Several physiopathology

studies highlighted the correlation between objective risk stratification and the success of the treatment plan

[5]. Severe COVID-19 cases were associated with remarkable increase in serum copeptin level when compared

to mild to moderate cases. Admission copeptin levels in COVID-19 patients were almost 4-fold higher in non

survivors cases. Among all biochemical and inflammatory markers, copeptin showed the best prognostic value

for COVID-19 severity with sensitivity and specificity of more than 90% [6]. Copeptin may be a useful

neuroendocrine biomarker of COVID-19 severity for better triage and effective management plan. Moreover,

it was determined that serum copeptin level was higher in COVID‐19 pneumonia patients compared to

community‐acquired pneumonia (CAP) patients. Copeptin distinguished COVID‐19 pneumonia with a

reasonable level of sensitivity and specificity[7].

Inflammation, pain, lung injury, plasma osmolarity changes and psychological stress associated with COVID-

19 are behind the activation of the stress-adapting endocrine axis. Endocrine stress conditioning is mediated

by several hormones, including AVP and cortisol. Pandemic physical and psychological impacts on healthcare

providers were considerable and contributed to systems overflow and failure in several critical scenarios [8].

Baseline copeptin concentration is significantly higher and more variable than Cortisol serum level in ICU staffs.

These findings suggested that copeptin might be a potential biomarker for physiological strain of health

practitioners working under pressure [9].

The need for quick accurate diagnosis and reliable prognostic assessment and treatment decisions has led to

the investigations of copeptin in various diseases. Copeptin was found as predictive of adverse outcomes in a

wide range of critical clinical situations. However, the lack of independency should be considered as it is the

stress and stressful scenarios biomarker hormone.

References

[1] Baranowska B, Kochanowski J. Copeptin -a new diagnostic and prognostic biomarker in neurological and cardiovascular diseases. Neuro Endocrinol Lett. 2019;40:207-14.

[2] Cao JX, Liu L, Sun YT, Zeng QH, Wang Y, Chen JC. Effects of the prophylactic use of escitalopram on the prognosis and the plasma copeptin level in patients with acute

cerebral infarction. Braz J Med Biol Res. 2020;53:e8930.

[3] Zhang J, Wang H, Li Y, Zhang H, Liu X, Zhu L, Dong L. The diagnosis and prognostic value of plasma copeptin in traumatic brain injury: a systematic review and meta-

analysis. Neurol Sci. 2021 ;42:539-51.

[4]. Gregoriano C, Molitor A, Haag E, Kutz A, Koch D, Haubitz S, et al. Activation of Vasopressin System During COVID-19 is associated with adverse clinical outcomes: An

observational study. J Endocr Soc. 2021;5:bvab045.

[5] Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. Predictors of COVID-19 severity: A literature review. Rev Med Virol. 2021 Jan;31(1):1-10.

[6] Tjendra Y, Al Mana AF, Espejo AP, Akgun Y, Millan NC, Gomez-Fernandez C, Cray C. Predicting Disease Severity and Outcome in COVID-19 Patients: A Review of Multiple

Biomarkers. Arch Pathol Lab Med. 2020;144:1465-74

[7] Kuluöztürk M, İn E, Telo S, Karabulut E, Geçkil AA. Efficacy of copeptin in distinguishing COVID-19 pneumonia from community-acquired pneumonia. J Med Virol. 2021

;93:3113-21.

[8] Cawcutt KA, Starlin R, Rupp ME. Fighting fear in healthcare workers during the COVID-19 pandemic. Infect Control Hosp Epidemiol. 2020 ;41:1192-93.

[9] Malik P, Patel U, Mehta D, Patel N, Kelkar R, Akrmah M, et al. Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis. BMJ Evid

Based Med. 2021;26:107-08.