Study: Copeptin levels signal perioperative stress in cardiac surgery with CPB

Editor's Note

Copeptin levels surge during cardiopulmonary bypass (CPB), marking it as a potential biomarker for physiological stress in cardiac surgery, according to a May 13 article in Medical Dialogues.

The article details a prospective cohort study, published in the Journal of Cardiothoracic and Vascular Anesthesia, involving 61 adult patients undergoing open-heart surgery with CPB at a tertiary care hospital, with 57 patients analyzed after exclusions. The team divided patients into two groups based on preoperative copeptin levels: those with levels above 10 pmol/L and those below. Copeptin, a stable peptide associated with cardiovascular stress, was measured at multiple timepoints—before surgery, at the start and throughout CPB, and for four days postoperatively.

The outlet reports that copeptin levels began rising after sternotomy, peaked around 60 minutes into bypass, and then plateaued. Levels declined after CPB ended but remained above baseline through postoperative day four. Patients with higher preoperative copeptin consistently showed greater elevations throughout the perioperative period, suggesting that baseline levels may predict the body’s stress response to surgery.

Statistical analysis confirmed significant variation in copeptin levels across timepoints, especially during major surgical milestones. However, Medical Dialogues notes that the study could not fully explain the physiological drivers of copeptin release during CPB. Limitations included the study’s small sample size, underrepresentation of women, and variability in patient numbers during CPB that hindered subgroup analysis.

The authors call for further studies to explore copeptin’s prognostic utility in cardiac surgery and its potential use in perioperative risk models.