Serum copeptin as a prognostic marker in pre-eclampsia

Objective: Pre-eclampsia (PE) is as a risk factor for subsequent cardiovascular and kidney disease. Serum copeptin correlates with adverse kidney outcomes in the general population and is increased during PE as compared to healthy pregnancy. We describe the association between copeptin and subsequent kidney outcomes in pregnant women. Design and method: We enrolled 372 patients with PE and 82 with healthy pregnancy in this prospective cohort study. Serum copeptin was measured at 6 weeks post-partum (PP). Office blood pressure (BP), eGFR and albuminuria were measured at 6 weeks as well as at 1 year PP in a sub-group of 110 patients. Interaction effect was tested using likelihood ratio test (LRT). Results: As compared to healthy controls, patients with PE were less frequently Caucasian, more likely smokers and had higher body mass index (p < 0.05). At 6 weeks PP, copeptin levels were similar between groups. At one year PP, systolic BP (SBP), diastolic BP (DBP) and albuminuria were higher in PE as compared to control patients (p < 0.05) while eGFR was similar between groups. A significant interaction existed between copeptin and PE status regarding DBP at 1 year PP (p = 0.045 for LRT). A similar but borderline interaction existed between copeptin and PE status for albuminuria at 1 year PP (p = 0.126 for LRT). Conclusions: At 6 weeks PP, women who suffered from PE do not have increased copeptin levels as compared to healthy controls. However, in case of PE only, copeptin levels are associated with subsequent adverse kidney outcome. Whether this association is causal and would represent a potential therapeutic target remains to be tested.