Copeptin as a marker of COVID-19 severity: A systematic review and meta-analysis

Introduction: Infection with SARS-CoV-2 is particularly hazardous in patients with cardiovascular pathology, diabetes or chronic lung disease. Arginine vasopressin (AVP), an antidiuretic hormone secreted in response to hemodynamic and osmotic disturbances plays a crucial role in maintenance of cardiovascular homeostasis. Copeptin has shown promising results regarding its utility in prediction of morbidity and mortality of COVID-19. Therefore, we conducted a meta-analysis to evaluate the role of copeptin in risk stratification in COVID-19. Methods: This study was designed as a systematic review and meta-analysis. We systematically searched the following databases: Scopus, Web of Science, PubMed, EMBASE, Cochrane Library through September 10th, 2022. Methodological quality was assessed using the Cochrane risk-of-bias tool. Results: Pooled analysis of four trials showed that mean copeptin plasma concentrations were higher in patients with severe course of COVID-19 than in patients with non-severe course of the disease (26.64 ± 13.59 vs. 16.75 ± 6.13, respectively; MD=9.39; 95%CI: 1.38 to 17.40; I2=99%; p=0.02). Furthermore, higher copeptin concentrations in COVID-19 patients who died than in those who survived (13.25 ± 3.23 vs. 44.65 ± 26.92, respectively; MD=-31.40; 95%CI:-42.93 to-19.87; p<0.001). Discussion: Results from the present meta-analysis revealed that increased copeptin plasma concentrations found in COVID-19 patients are associated with the severity of the disease. Copeptin may assist in early identification of COVID-19 progression and possibly in prediction of adverse outcomes, thus its use in risk stratification could be beneficial. Take-home message: Copeptin may assist in early identification of COVID-19 progression and possibly in prediction of adverse outcomes, thus its use in risk stratification could be beneficial.