Copeptin levels as a predictor of acute kidney injury (AKI) in ST-segment elevation myocardial infarction (STEMI)

Background: Acute myocardial infarction is a cardiac emergency with a high mortality rate. The ST-segment elevation myocardial infarction (STEMI) patients have complete coronary artery occlusion, so they usually present with severe symptoms and a higher risk of early mortality. The prevalence of type 1 cardiorenal syndrome (CRS), namely acute kidney injury (AKI) in acute heart failure, is 24%-45%. Copeptin is the C-terminus of pro-vasopressin's peptide, the arginine vasopressin's precursor. This study aimed to prove whether copeptin is a predictor of AKI in the STEMI patient population after adjusting for confounding variables. Methods: This prospective cohort study was conducted between March and December 2020. Eighty-four subjects with STEMI who came to the emergency department at Dr. Moewardi Hospital and met the inclusion and exclusion criteria were enrolled. The data were analyzed to calculate relative risk and 95%CI for each variable, followed by multivariate analysis with logistic regression. Data were analyzed using SPSS version 23 for Windows. Results: The prevalence of AKI in this study was 67%. The copeptin level at the cut-off of 273.6 pg/ml has an AUC of 0.774 (95%CI=0.676-0.873, p=0.000). Copeptin level, acute heart failure, and risk of renal ischemia associated with AKI in STEMI. Copeptin >273.6 pg/ml showed a statistically significant association with AKI in STEMI (adjusted RR 5.298; 95%CI=1.77-115.847; p=0.003). Conclusion: Copeptin levels higher than 273.6 pg/ml is known to be an independent predictor of AKI in STEMI.