# Efficacy of blood copeptin level for the prediction of mortality of adult patients with sepsis: a meta-analysis

## TL;DR

This study finds that high blood copeptin levels within 48 hours of sepsis diagnosis can predict mortality in adult patients, suggesting its potential use in clinical risk assessment.

## Contribution

The study provides a meta-analysis confirming the prognostic accuracy of copeptin for mortality prediction in sepsis patients.

## Key findings

- Elevated copeptin levels showed pooled sensitivity of 0.77 and specificity of 0.76 for predicting mortality in sepsis patients.
- The diagnostic odds ratio was 10.40, and the area under the summary receiver operating characteristic curve was 0.83, indicating good prognostic accuracy.
- No significant publication bias was detected, supporting the robustness of the findings.

## Abstract

Copeptin, the C-terminal fragment of provasopressin, has emerged as a potential prognostic biomarker in sepsis. However, its predictive accuracy for mortality in adult patients with sepsis remains uncertain. We conducted a systematic review and meta-analysis to evaluate the diagnostic performance of elevated blood copeptin levels for mortality prediction in this population.

We systematically searched PubMed, Embase, Web of Science, Wanfang Data, and CNKI from inception to 22 May 2025, for observational studies assessing copeptin levels at admission or within 48 h in adults with sepsis. Pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC) were calculated using a random-effects model. Study quality was assessed using QUADAS-2.

Ten prospective studies involving 1,637 patients were included. Pooled sensitivity and specificity of elevated copeptin for predicting mortality were 0.77 (95% CI: 0.70–0.83; I2 = 52%) and 0.76 (95% CI: 0.67–0.83; I2 = 86%), respectively. The pooled positive and negative likelihood ratios were 3.16 (95% CI: 2.33–4.29) and 0.30 (95% CI: 0.23–0.40), with a DOR of 10.40 (95% CI: 6.62–16.33). The summary AUC was 0.83 (95% CI: 0.79–0.86), indicating good overall prognostic accuracy. Subgroup analysis according to the cutoffs of copeptin did not significantly affect the results. No significant publication bias was detected (p = 0.58).

Elevated blood copeptin levels within 48 h of sepsis diagnosis show good prognostic accuracy for short-term mortality in adult patients with sepsis. These findings support the potential clinical utility of copeptin as a risk stratification tool in sepsis management.

https://www.crd.york.ac.uk/prospero/, identifier CRD42024587540.