Perioperative copeptin elevations and prediction of myocardial injury and acute kidney injury after abdominal surgery: A preliminary prospective observational study

BACKGROUND: Myocardial injury after noncardiac surgery (MINS) and acute kidney injury (AKI) are important postoperative complications. Early identification of patients at risk remains challenging. Copeptin, a stable surrogate marker of arginine vasopressin release, may be useful for perioperative risk stratification. METHODS: This prospective observational study enrolled 44 patients undergoing major abdominal surgery. Plasma copeptin concentrations were measured preoperatively, immediately after surgery, and on postoperative days 1 and 2. MINS was defined using a prespecified high-sensitivity cardiac troponin T-based definition, and AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Perioperative copeptin kinetics and its predictive performance for MINS and AKI within 48 h were evaluated using receiver operating characteristic (ROC) curve analysis. Exploratory analyses examined the relationship between copeptin and preoperative renal function, and sensitivity analyses were performed using alternative troponin-based definitions of MINS. RESULTS: Plasma copeptin concentrations increased sharply after surgery and declined over subsequent postoperative days (overall time effect, p < 0.001). Immediate postoperative copeptin showed moderate discrimination for MINS, with an area under the ROC curve (AUC) of 0.736 (95% confidence interval [CI], 0.582-0.857). The predictive performance for AKI was limited (AUC: 0.635, 95% CI, 0.477-0.775). CONCLUSION: Perioperative copeptin rises rapidly after major abdominal surgery and shows moderate discrimination for MINS, but limited performance for AKI. These preliminary findings support further evaluation of copeptin as an adjunctive early biomarker for perioperative myocardial injury risk stratification in larger, multicenter cohorts.