Skip to main content Skip to main navigation menu Skip to site footer

Copeptin levels as a predictor of acute kidney injury (AKI) in ST-segment elevation myocardial infarction (STEMI)

  • Dian Ariningrum ,
  • Mas Aditya Senaputra ,
  • Sumardiyono ,
  • Purwanto Adhi Pireno ,
  • Lisyani B. Suromo ,


Background: Acute myocardial infarction is a cardiac emergency with a high mortality rate. The ST-segment elevation myocardial infarction (STEMI) patients have complete coronary artery occlusion, so they usually present with severe symptoms and a higher risk of early mortality. The prevalence of type 1 cardiorenal syndrome (CRS), namely acute kidney injury (AKI) in acute heart failure, is 24%-45%. Copeptin is the C-terminus of pro-vasopressin's peptide, the arginine vasopressin's precursor. This study aimed to prove whether copeptin is a predictor of AKI in the STEMI patient population after adjusting for confounding variables.

Methods: This prospective cohort study was conducted between March and December 2020. Eighty-four subjects with STEMI who came to the emergency department at Dr. Moewardi Hospital and met the inclusion and exclusion criteria were enrolled. The data were analyzed to calculate relative risk and 95%CI for each variable, followed by multivariate analysis with logistic regression. Data were analyzed using SPSS version 23 for Windows.

Results: The prevalence of AKI in this study was 67%. The copeptin level at the cut-off of 273.6 pg/ml has an AUC of 0.774 (95%CI=0.676-0.873, p=0.000). Copeptin level, acute heart failure, and risk of renal ischemia associated with AKI in STEMI. Copeptin >273.6 pg/ml showed a statistically significant association with AKI in STEMI (adjusted RR 5.298; 95%CI=1.771-15.847; p=0.003).

Conclusion: Copeptin levels higher than 273.6 pg/ml is known to be an independent predictor of AKI in STEMI.


  1. Anderson JL, Morrow DA. Acute myocardial infarction, NEJM. 2017;376:2053-64.
  2. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI) Pedoman Tata Laksana Sindrom Koroner Akut. Edisi IV. 2018:1-94.
  3. Gottlieb SS, Abraham W, Butler J, Forman DE, Loh E, Massie BM, et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure, J Card Fail. 2002;8:136–41
  4. Cowie MR, Komajda M, Murray-Thomas T, Underwood J, Ticho B. POSH Investigators: Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective out- comes study in heart failure (POSH), Eur Heart J. 2006;27:1216–22.
  5. Parikh CR, Coca SG, Wang Y, Masoudi FA, Krumholz HM. Long-term prognosis of acute kidney injury after acute myocardial infarction, Arch Intern Med. 2008;168:987–95.
  6. Kidney Disease Improving Global Outcomes. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int. Supp. 2012;2: 1-141
  7. Amin AP, Spertus JA, Reid KJ, Lan X, Buchanan DM, Decker C, et al. The prognostic importance of worsening renal function during an acute myocardial infarction on long-term mortality, Am Heart J. 2010;16:1065–71.
  8. Sinkovic A, Masnik K, Mihevc M. Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study, Bosn J Basic Med Sci. 2019;19(1):101-8.
  9. Clerico A, Galli C, Fortunato A, Ronco C Neutrophil gelatinase-associated lipocalin (NGAL) as biomarker of acute kidney injury: a review of the laboratory characteristics and clinical evidence, Clin Chem Lab Med. 2012;50:1505–17.
  10. McMahon GM, Waikar SS. Biomarkers in Nephrology: Core Curriculum, Am J Kidney Dis. 2013;62(1):165-78
  11. Elshafei A, Abdalla G, El-Motaal OA, Salman T. Copeptin: a neuroendocrine biomarker in acute myocardial infarction. Annual review & research in biology. SCIENCE DOMAIN Internasional. 2013;3(4):1040-1054.
  12. Nursalim A, Suryaatmadja M, Panggabean M. Potential clinical application of novel cardiac biomarkers for acute myocardial infarction. Acta medical Indonesiana – The Indonesian journal of internal medicine. 2013;45(3):240 – 50.
  13. Kristyagita A, Siswanto BB. The role of copeptin as a novel cardiovascular biomarker, Medical Journal Indonesia. 2015;24:59 – 66.
  14. Cosentino N, Genovese S, Campodonico J, Bonomi A, Lucci C, Milazzo V, Moltrasio M, et al. High-Sensitivity C-Reactive Protein and Acute Kidney Injury in Patients with Acute Myocardial Infarction: A Prospective Observational , J. Clin. Med. 2019;8:2192.
  15. Neves D, Belo A, Damasio AF, Carvalho J, Santos AR, Picarra B, Aguiar J, et al. Acute kidney injury in acute coronary syndromes-An important multifactorial consequence, Rev Port Cardiol. 2016;35(7-8):415-21
  16. Ortega-Hernandez J, Springall R, Sanchez-Munoz F, Arana-Martinez JC, Gonzalez-Pacheco H, Bojalil R. Acute coronary syndrome and acute kidney injury: role of inflammation in worsening renal function, BMC Cardiovascular Disorders. 2017;17:202.
  17. Amin AP, Salisbury AC, McCullough PA, Gosch K, Spertus JA, Venkitachalam L, Stolker JM, Parikh CR, Masoudi FA, Jones PG, Kosiborod M. Trends in the incidence of acute kidney injury in patients hospitalized with acute myocardial infarction, Arch Intern Med. 2012;172:246–53.
  18. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL. Investigators A. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med. 2017;376(1):11–20.
  19. Sun YB, Liu BC, Zou Y, Pan JR, Tao Y, Yang M. Risk factors of acute kidney injury after acute myocardial infarction, Renal Failure. 2016;38:9:1353-1358.
  20. Arguelles E, de Elia C, Lasic Z, 2014, Acute Cardiorenal Syndrome Type 1 in Patients With Congestive Heart Failure Exacerbations Is Not an Indicator of Poor Outcome and Increased Mortality, Cardiol Res. 2014;5(2):72-74.
  21. Fuhrman DY, Gill SK, Goldstein SL, Priyanka P, Kellum JA. Acute kidney injury epidemiology, risk factors, and outcomes in critically ill patients 16–25 years of age treated in an adult intensive care unit, Ann. Intensive Care. 2018;8:26.
  22. Hu W, He W, Liu W, Fang X, Wu Y, Yu F, Hao W. Risk Factors and Prognosis of Cardiorenal Syndrome Type 1 in Elderly Chinese Patients: A Retrospective Observational Cohort Study, Kidney Blood Press Res. 2016;41:672-79.
  23. Hoste EA, Bagshaw SM, Bellomo R, et al.Epidemiology of acute kidney injury in critically ill patients: the multinational AKI‐EPI study, Intensive Care Med. 2015; 41(8):1411–23.
  24. Kanic V, Vollrath M, Kompara G, Suran D, Hojs R. Women and acute kidney injury in myocardial infarction, Journal of Nephrology. 2018:21-29.
  25. Watabe H, Sato A, Hoshi T, Takeyasu N, Abe D, Akiyama D et al. Association of contrast-induced acute kidney injury with long-term cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention, Int J Cardiol. 2014;174:57–63.
  26. Kim JH, Yang JH, Choi SH, Song YB, Hahn JY, Choi JH et al. Predictors of outcomes of contrast-induced acute kidney injury after percutaneous coronary intervention in patients with chronic kidney disease, Am J Cardiol. 2014;114:1830–5.
  27. Choi JS, Kim YA, Kim MJ, Kang YU, Kim CS, Bae EH et al. Relation between transient or persistent acute kidney injury and long-term mortality in patients with myocardial infarction, Am J Cardiol. 2013;112: 41–45
  28. Margolis G, Gal-Oz A, Letourneau-Shesaf S, Khoury S, Keren G, Shacham Y. Acute kidney injury based on the KDIGO criteria among ST-elevation myocardial infarction patients treated by primary percutaneous intervention. J Nephrol. 2017;54-59.
  29. Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Généreux P. et al. Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy, Eur Heart J. 2014;35:1533–40.
  30. Han SS, Baek SH, Ahn SY, Chin HJ, Na KY, Chae DW, et al. anemia is a risk factor for acute kidney injury and long‐term mortality in critically ill patients, Tohoku J Exp Med. 2015;237(4):287–95.
  31. Wang C, Pei YY, Ma YH, Ma XL, Liu ZW, Zhu JH, Li CS. Risk factors for acute kidney injury in patients with acute myocardial infarction, Chinese Medical Journal. 2019;132:14.
  32. Metra M, Cotter G, Gheorghiade M, Cas LD, Voors AA. The role of the kidney in heart failure, Eur Heart J. 2019;33:2135–42.
  33. Eren Z, Ozveren O, Buyukoner E, Kaspar E, Degertekin M, Kantarci G. A Single-Centre Study of Acute Cardiorenal Syndrome: Incidence, Risk Factors and Consequences, Cardiorenal Med. 2012;2:168–176
  34. Lehman LW, Saeed M, Moody G, Mark R. Hypotension as a Risk Factor for Acute Kidney Injury in ICU Patients, Computing in Cardiology. 2010;37:1095−98
  35. Badin J, Boulain T, Ehrmann S, Skarzynski M, Bretagnol A, Buret J, et al. Relation between mean arterial pressure and renal function in the early phase of shock: a prospective, explorative cohort study, Critical Care. 2011:15;R135.
  36. Magalhaes PAF, de Brito TS, Freire RS, daSilva MTB, dosSantos AA, Vale ML, deMenezes DB et al. Metabolic acidosis aggravates experimental acute kidney injury, Life Sciences. 2016;146:58–65.
  37. Herawati S, Kandarini Y, Prabawa IPY. The Correlation between Estimated Glomerular Filtration Rate and Parathyroid Hormone Levels in Predialysis-chronic Kidney Disease Adult Patients at Sanglah General Hospital, Bali, Indonesia. Open Access Maced J Med Sci. 2021;9(B):470-4.
  38. Worung IM, Lestari AAW, Kandarini Y, Wande IN, Wirawati IAP, Mahartini NN. Correlation between serum levels of Fibroblast Growth Factor-23 (FGF-23) and parathyroid hormone levels in predialysis Chronic Kidney Disease (CKD) patients at Sanglah General Hospital, Bali, Indonesia. Bali Medical Journal. 2021;10(2): 830–834.
  39. Sheng XS, Lin L, Guo FM, Liang SX, Chen HH, Fang FS, Ding MX. Copeptin level in the early prediction of cardiorenal syndrome in rats, Experimental and Therapeutic Medicine. 2018;16:937-44
  40. Ponte B, Pruijm M, Ackerman D, Vuistiner P, Guessous I, Ehret G, Alwan H, et al. Copeptin Is Associated with Kidney Length, Renal Function, and Prevalence of Simple Cysts in a Population-Based Study, J Am Soc Nephrol 2015;26:1415–25.
  41. Balanescu S, Kopp P, Gaskill MB, Morgenthaler NG, Schindler C, Rutishauser J. Correlation of Plasma Copeptin and Vasopressin Concentrations in Hypo-, Iso-, and Hyperosmolar States, J Clin Endocrinol Metab. 2011;96:1046 –52.

How to Cite

Ariningrum, D., Senaputra, M. A., Sumardiyono, Purwanto Adhi Pireno, & Suromo, L. B. (2023). Copeptin levels as a predictor of acute kidney injury (AKI) in ST-segment elevation myocardial infarction (STEMI). Bali Medical Journal, 12(1), 391–397.




Search Panel

Dian Ariningrum
Google Scholar
BMJ Journal

Mas Aditya Senaputra
Google Scholar
BMJ Journal

Google Scholar
BMJ Journal

Purwanto Adhi Pireno
Google Scholar
BMJ Journal

Lisyani B. Suromo
Google Scholar
BMJ Journal