Copeptin and mid‐regional pro‐ANP in women with suspected or confirmed pre‐eclampsia: comparison with the sFlt‐1/PlGF ratio

OBJECTIVES: Arginine vasopressin (AVP) and atrial natriuretic peptide (ANP) may contribute to the pathogenesis of preeclampsia, but their role remains to be elucidated. We aimed to evaluate their role as biomarkers and whether they associate with angiogenic markers and/or clinical manifestations of preeclampsia. METHODS: We measured their surrogates C-terminal pro-AVP (Copeptin) and mid-regional pro-ANP (MR-proANP) making use of a retrospective analysis of a prospective cohort study involving 526 women with suspected or confirmed preeclampsia, originally aimed to evaluate the use of soluble Fms-like tyrosine kinase-1/Placental growth factor (sFlt-1/PlGF) ratio. RESULTS: Women with preeclampsia displayed elevated serum copeptin and MR-proANP in comparison with women suspected of preeclampsia. To discriminate maternal complications on top of traditional predictors (gestational age, parity, diastolic blood pressure and proteinuria), the sFlt-1/PlGF ratio displayed a higher C-index than copeptin and MR-proANP (0.76, 0.63 and 0.67, respectively, vs. 0.60 for the traditional predictors only), and the same was true for the discrimination of fetal/neonatal complications (C-index = 0.83, 0.79 and 0.80 vs. 0.79). When subdividing women according to sFlt-1/PlGF ratio (>/= 85 versus /= 85. Multiple regression analysis revealed that copeptin and MR-proANP were independent determinants of proteinuria. CONCLUSION: Copeptin and MR-proANP have limited value to predict preeclampsia-related complications when compared with the sFlt-1/PlGF ratio. However, our data suggests that both copeptin and MR-proANP contribute to the occurrence of proteinuria, with copeptin exerting this effect independently of sFlt-1/PlGF ratio. This article is protected by copyright. All rights reserved.