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Purpose <p>Copeptin is an emerging biomarker for polyuria-polydipsia syndrome. Postoperative copeptin levels may predict acquired arginine vasopressin deficiency (AVP-D). This prospective study evaluated the diagnostic performance of serum copeptin for predicting postoperative AVP-D after transsphenoidal surgery (TSS).</p> Methods <p>Copeptin was measured preoperatively, immediately after surgery (periextubation, T0), upon first ward arrival (T1), daily until discharge, and at week 2. Delta copeptin was calculated as the percentage change from T0 to T1.</p> Results <p>Of 53 patients, 23 (43.4%) developed AVP-D, including 4 (7.5%) permanent and 19 (35.8%) transient cases. The AVP-D group showed significantly lower delta copeptin (median  -38% vs. +66%, <i>p</i> &lt; 0.001), day 2 (median 3.1 vs. 4.0 pmol/L, <i>p</i> = 0.021), and week 2 levels (median 2.5 vs. 3.2 pmol/L, <i>p</i> = 0.021) compared with the non-AVP-D group.</p> <p>Delta copeptin (area under the curve 0.826, <i>p</i> = 0.001) demonstrated the best diagnostic performance for AVP-D with an optimal cutoff of &lt; -10% (sensitivity 100%, specificity 76.2%). All AVP-D patients exhibited negative delta copeptin. Week 2 copeptin (area under the curve 0.891, <i>p</i> = 0.011) predicted permanent AVP-D best with an optimal cutoff of &lt; 2.6 pmol/L (sensitivity 100%, specificity 66.7%). </p> Conclusions <p>Delta copeptin—the change in copeptin levels from T0 (periextubation) to T1 (2–4 h post-surgery)—predicted AVP-D after TSS. We recommend measuring copeptin immediately after surgery and repeat at 2–4 h. Patients with positive delta copeptin were unlikely to develop AVP-D. A copeptin value &gt; 2.6 pmol/L at week 2 ruled out permanent AVP-D.</p>

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COPeptin Evaluation in arginine vasopressin Deficiency post transsphenoidal surgery (COPED study)

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Fung Kuen Tam,
  • Hiu Yan Chan,
  • Ming Him Yuen,
  • Hoi Kwan Calvin Mak,
  • Mei Tik Stella Leung,
  • Choi Yee Lau,
  • Po Shan Judy Lai,
  • Pak Lam Sammy Chen,
  • Chi Chung Shek,
  • Sze Wai Karen Lee,
  • Yew Chuan David Chong,
  • Chiu Ming Ng,
  • Cheung Hei Choi

摘要

Purpose

Copeptin is an emerging biomarker for polyuria-polydipsia syndrome. Postoperative copeptin levels may predict acquired arginine vasopressin deficiency (AVP-D). This prospective study evaluated the diagnostic performance of serum copeptin for predicting postoperative AVP-D after transsphenoidal surgery (TSS).

Methods

Copeptin was measured preoperatively, immediately after surgery (periextubation, T0), upon first ward arrival (T1), daily until discharge, and at week 2. Delta copeptin was calculated as the percentage change from T0 to T1.

Results

Of 53 patients, 23 (43.4%) developed AVP-D, including 4 (7.5%) permanent and 19 (35.8%) transient cases. The AVP-D group showed significantly lower delta copeptin (median  -38% vs. +66%, p < 0.001), day 2 (median 3.1 vs. 4.0 pmol/L, p = 0.021), and week 2 levels (median 2.5 vs. 3.2 pmol/L, p = 0.021) compared with the non-AVP-D group.

Delta copeptin (area under the curve 0.826, p = 0.001) demonstrated the best diagnostic performance for AVP-D with an optimal cutoff of < -10% (sensitivity 100%, specificity 76.2%). All AVP-D patients exhibited negative delta copeptin. Week 2 copeptin (area under the curve 0.891, p = 0.011) predicted permanent AVP-D best with an optimal cutoff of < 2.6 pmol/L (sensitivity 100%, specificity 66.7%).

Conclusions

Delta copeptin—the change in copeptin levels from T0 (periextubation) to T1 (2–4 h post-surgery)—predicted AVP-D after TSS. We recommend measuring copeptin immediately after surgery and repeat at 2–4 h. Patients with positive delta copeptin were unlikely to develop AVP-D. A copeptin value > 2.6 pmol/L at week 2 ruled out permanent AVP-D.