BACKGROUND Early prognostication in trauma patients is challenging, but particularly important. We wanted to explore the ability of copeptin, the C-terminal fragment of arginine vasopressin, to identify major trauma, defined as Injury Severity Score (ISS) > 15, in a heterogeneous cohort of trauma patients and to compare its performances with lactate. We also evaluated copeptin performance in predicting other clinical outcomes: mortality, hospital admission, blood transfusion, emergency surgery, and Intensive Care Unit (ICU) admission. METHODS This single center, pragmatic, prospective observational study was conducted at Arcispedale Santa Maria Nuova, a level II trauma center in Reggio Emilia, Italy. Copeptin determination was obtained on Emergency Department (ED) arrival, together with venous lactate. Different outcomes were measured including ISS, Revised Trauma Score (RTS), hospital and ICU admission, blood transfusion, emergency surgery, and mortality. RESULTS One hundred and twenty five adult trauma patients admitted to the ED between June 2017 and March 2018. Copeptin showed a good ability to identify patients with ISS > 15 (AUC 0.819). Similar good performances were recorded also in predicting other outcomes. Copeptin was significantly superior to lactate in identifying patients with ISS > 15 (P 0.0015), and in predicting hospital admission (P 0.0002) and blood transfusion (P 0.016). Comparable results were observed in a subgroup of patients with RTS 7.84. CONCLUSIONS In a heterogeneous group of trauma patients, a single copeptin determination at the time of ED admission proved to be an accurate biomarker, statistically superior to lactate for the identification of major trauma, hospital admission, and blood transfusion, while no statistical difference was observed for ICU admission and emergency surgery. These results, if confirmed, may support a role for copeptin during early management of trauma patients.

中文翻译：

---

急诊科中的血清copeptin水平可预测成人创伤患者的主要临床结局。

背景技术创伤患者的早期预后具有挑战性，但特别重要。我们想探索精氨酸加压素C末端肽copeptin在异质性创伤患者队列中识别严重创伤的能力，该严重创伤定义为伤害严重度评分（ISS）> 15，并将其表现与乳酸进行比较。我们还评估了肽素在预测其他临床结局中的表现：死亡率，住院率，输血，急诊手术和重症监护病房（ICU）入院率。方法在意大利雷焦艾米利亚的II级创伤中心Arcispedale Santa Maria Nuova进行了这项单中心，实用，前瞻性的观察性研究。急诊科（ED）抵达时获得了共肽素的测定以及静脉内乳酸。测量了不同的结局，包括ISS，创伤评分（RTS），住院和ICU入院，输血，急诊手术和死亡率。结果在2017年6月至2018年3月之间，有125名成年外伤患者被纳入急诊科。Copeptin具有很好的识别ISS> 15（AUC 0.819）患者的能力。在预测其他结果时也记录了类似的良好表现。在鉴定ISS> 15的患者中，copeptin明显优于乳酸（P = 0.0015），在预测住院率（P 0.0002）和输血（P = 0.016）方面。在RTS 7.84的亚组患者中观察到了可比的结果。结论在一组不同类型的创伤患者中，ED入院时一次肽素测定被证明是准确的生物标志物，在识别重大创伤，入院和输血方面，统计学上优于乳酸，而在ICU入院和急诊手术中未观察到统计学差异。如果得到证实，这些结果可能支持肽素在创伤患者的早期治疗中的作用。