OBJECTIVE Arginine vasopressin deficiency (AVD) following neurosurgical procedures for pituitary disorders is common and can delay discharge. Copeptin, a stable surrogate marker of arginine vasopressin, may predict postoperative AVD. The authors' aim was to assess the optimal postoperative sampling time and cut-point concentration of copeptin to predict the development of postsurgical AVD. METHODS Adults without preexisting AVD who were undergoing surgery for a pituitary lesion between February 2020 and April 2022 were eligible for study inclusion. Two samples were drawn from each patient postoperatively to assess the copeptin concentration using an immunofluorescent assay. Samples were denoted as "early" (within 6 hours of extubation) or "postoperative day 1" (POD1; within 10-30 hours of extubation). Patients were evaluated for the development of AVD. RESULTS One hundred ninety-two patients (54.2% female) with a median age of 54.5 years (IQR 39.8-67.0 years) were included in the study. The median copeptin concentration at both time points was significantly lower in those with AVD (transient or permanent; n = 22, 11.5%) than in those without (early: 4.9 vs 18.7 pmol/L, p < 0.001; POD1: 3.4 vs 4.9 pmol/L, p < 0.001) but did not differ in those who developed transient versus permanent AVD. The optimal copeptin cut point for the prediction of AVD was < 8.5 pmol/L for early samples (sensitivity 0.70, specificity 0.80, positive predictive value [PPV] 0.29, negative predictive value [NPV] 0.96) and < 4.3 pmol/L for POD1 samples (sensitivity 0.82, specificity 0.63, PPV 0.22, NPV 0.96). In early samples, a copeptin cutoff of 22.9 pmol/L increased the sensitivity for the detection of AVD to 95% with an NPV of 99%. The proportion of patients who had AVD was higher (60.0% vs 8.8%, p < 0.001) and the copeptin concentration lower (early: 4.3 vs 17.0 pmol/L, p < 0.001; POD1: 2.7 vs 4.9 pmol/L, p < 0.001) among those who had undergone surgery for a craniopharyngeal duct pathology versus a pituitary adenoma. Although copeptin was lower in patients with persistent Cushing's disease than in those in remission, the difference did not reach statistical significance (early p = 0.11, POD1 p = 0.52). Furthermore, the copeptin concentration could not predict the development of syndrome of inappropriate secretion of antidiuretic hormone. Patients without AVD who had received stress dose steroids intraoperatively had lower median early copeptin (11.7 vs 19.1 pmol/L, p = 0.027). CONCLUSIONS In early postoperative copeptin samples, the optimal copeptin cut point for AVD diagnosis was < 8.5 pmol/L, and a level > 22.9 pmol/L had predicative utility in excluding AVD. Caution should be used when interpreting copeptin results, as patients administered glucocorticoids intraoperatively without AVD had lower median copeptin concentrations.

中文翻译：

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和肽素用于预测术后精氨酸加压素缺乏的术后效用。

目的 垂体疾病神经外科手术后精氨酸加压素缺乏 (AVD) 很常见，可能会延迟出院。和肽素是精氨酸加压素的稳定替代标记物，可以预测术后 AVD。作者的目的是评估最佳术后采样时间和和肽素的切点浓度，以预测术后 AVD 的发展。方法 2020 年 2 月至 2022 年 4 月期间接受垂体病变手术、既往没有 AVD 的成年人有资格纳入研究。术后从每位患者身上抽取两个样本，以使用免疫荧光测定法评估和肽素浓度。样本被标记为“早期”（拔管后 6 小时内）或“术后第 1 天”（POD1；拔管后 10-30 小时内）。对患者 AVD 的发生情况进行评估。结果 本研究纳入了 192 名患者（54.2% 为女性），中位年龄为 54.5 岁（IQR 39.8-67.0 岁）。AVD 患者（短暂或永久；n = 22, 11.5%）在两个时间点的中位和肽素浓度均显着低于无 AVD 患者（早期：4.9 vs 18.7 pmol/L，p < 0.001；POD1：3.4 vs 4.9） pmol/L，p < 0.001），但在发生暂时性 AVD 的患者与发生永久性 AVD 的患者中没有差异。早期样本预测 AVD 的最佳和肽素切点为 < 8.5 pmol/L（敏感性 0.70，特异性 0.80，阳性预测值 [PPV] 0.29，阴性预测值 [NPV] 0.96），POD1 的最佳切点为 < 4.3 pmol/L样本（灵敏度 0.82，特异性 0.63，PPV 0.22，NPV 0.96）。在早期样本中，和肽素截止值为 22.9 pmol/L，将 AVD 检测的灵敏度提高至 95%，NPV 为 99%。患有 AVD 的患者比例较高（60.0% vs 8.8%，p < 0.001），和肽素浓度较低（早期：4.3 vs 17.0 pmol/L，p < 0.001；POD1：2.7 vs 4.9 pmol/L，p < 0.001）在因颅咽管病理学与垂体腺瘤而接受手术的患者中。尽管持续性库欣病患者的和肽素水平低于缓解期患者，但差异并未达到统计学显着性（早期 p = 0.11，POD1 p = 0.52）。此外，和肽素浓度不能预测抗利尿激素分泌不当综合征的发生。无 AVD 且术中接受应激剂量类固醇的患者早期和肽素中位数较低（11.7 vs 19.1 pmol/L，p = 0.027）。结论 在术后早期和肽素样本中，诊断 AVD 的最佳和肽素切点为 < 8.5 pmol/L，水平 > 22.9 pmol/L 对排除 AVD 具有预测作用。在解释和肽素结果时应谨慎，因为术中使用糖皮质激素但未进行 AVD 的患者的中位和肽素浓度较低。