The online version of this article (doi:10.1186/1475-2875-11-6) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
MEvW contributed to the data acquisition and analysis and writing of the manuscript. DAH, EJH and JvH participated in the data analysis and revising of the manuscript. YdeR carried out the copeptin measurements and contributed to the data analysis. RK is responsible for collection of patient materials and database management. PJvG participated in the data acquisition and analysis and in writing and revising the manuscript. All authors have read and approved the final version.
Copeptin has recently been identified to be a stable surrogate marker for the unstable hormone arginine vasopressin (AVP). Copeptin has been shown to correlate with disease severity in leptospirosis and bacterial sepsis. Hyponatraemia is common in severe imported malaria and dysregulation of AVP release has been hypothesized as an underlying pathophysiological mechanism. The aim of the present study was to evaluate the performance of copeptin as a predictor of disease severity in imported malaria.
Copeptin was measured in stored serum samples of 204 patients with imported malaria that were admitted to our Institute for Tropical Diseases in Rotterdam in the period 1999-2010. The occurrence of WHO defined severe malaria was the primary end-point. The diagnostic performance of copeptin was compared to that of previously evaluated biomarkers C-reactive protein, procalcitonin, lactate and sodium.
Of the 204 patients (141 Plasmodium falciparum, 63 non-falciparum infection), 25 had severe malaria. The Area Under the ROC curve of copeptin for severe disease (0.66 [95% confidence interval 0.59-0.72]) was comparable to that of lactate, sodium and procalcitonin. C-reactive protein (0.84 [95% CI 0.79-0.89]) had a significantly better performance as a biomarker for severe malaria than the other biomarkers.
C-reactive protein but not copeptin was found to be an accurate predictor for disease severity in imported malaria. The applicability of copeptin as a marker for severe malaria in clinical practice is limited to exclusion of severe malaria.
Additional file 1: Figure S1 A two-step decision rule including the combined use of C-reactive protein and Procalcitonin to identify all patients with severe malaria on admission. Legend: SF = severe P. falciparum malaria; NSF = non-severe P. falciparum malaria; NSNF = non-severe, non-falciparum malaria; CRP = C-reactive protein; PCT = Procalcitonin. (JPEG 4 MB)12936_2011_1953_MOESM1_ESM.JPEG
Additional file 2: Table S1 Impact of the number of severity criteria on the level of the biomarker on admission in malaria patients with severe disease. (DOC 28 KB)12936_2011_1953_MOESM2_ESM.DOC
Authors’ original file for figure 112936_2011_1953_MOESM3_ESM.pdf
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- Copeptin does not accurately predict disease severity in imported malaria
Marlies E van Wolfswinkel
Dennis A Hesselink
Ewout J Hoorn
Yolanda B de Rijke
Jaap J van Hellemond
Perry JJ van Genderen
- BioMed Central
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