Copeptin as a stress marker prior and after a written examination – the CoEXAM study

Abstract

The stress hormone copeptin, which is co-secreted with arginine vasopressin, increases in seriously ill patients and can predict outcome in several organic diseases. Information about the influence of psychological stress on copeptin levels is lacking, but is important for interpretation of copeptin levels in the clinical setting. The aim of this study was to evaluate the influence of psychological stress on copeptin levels. We measured copeptin levels in 25 healthy medical students before and after a written examination. The primary endpoint was change in copeptin levels from immediately prior to examination compared with after the examination. Median copeptin levels prior to the examination were significantly higher than those after its conclusion. Similar results were found for serum cortisol and salivary cortisol. Serum cortisol prior to examination was significantly higher in students with a superior examination result, compared to those with a lower score. In conclusion, psychological stress leads to a subtle increase in copeptin level and might therefore be taken into account as a confounding factor in disorders with small diagnostic copeptin range. Higher cortisol levels, but not copeptin, correlated with a better academic performance in this cohort of students.

• Copeptin
• cortisol
• examination outcome
• HPA axis
• medical students
• psychological stress
• stress marker

Acknowledgements

We thank the staff of the laboratory, the staff of the Department of Endocrinology, Diabetology & Metabolism and our study nurses, especially Cemile Bathelt, Susanne Mueller and Silke Purschke, for their helpful support during this study. For the most helpful review of our manuscript, we thank Dr. Albert Shun, Head of the Liver and Renal Transplantation Unit at the Children’s Hospital, Westmead, Sydney, Australia.

Declaration of interest

This study was supported by a grant from the Swiss National Science Foundation (Swiss National Foundation Professorship), no. PP00P3-12346, to M. C-C. M. C-C. and P. S. have received speaking honoraria and research support from Thermo Scientific Biomarkers (formerly B·R·A·H·M·S AG), the copeptin assay developer and manufacturer. C. S. and S. A. U. have no disclosures.

ClincalTrials.gov number NCT02051647.