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Endocrine Abstracts (2015) 37 GP17.04 | DOI: 10.1530/endoabs.37.GP.17.04

1Imperial College, London, UK, 2Royal Centre for Defence Medicine, Birmingham, UK; 3Carnegie Faculty Leeds Beckett University, Leeds, UK; 4Hammersmith Hospital, London, UK, 5Institute of Naval Medicine, Alverstoke, Hants, UK.


Background: Exertional heat illness (EHI) is an incapacitating and sometimes fatal phenomenon. It is associated with elevated core temperature (Tc), cardiovascular instability and the systemic inflammatory response syndrome. EHI-preventive guidelines recommend maintaining Tc ≤38 °C, an important thermoregulatory threshold above which vasomotor compensation plateaus and pronounced excursions in key pituitary and adrenal hormones occur. Copeptin, the C-terminal part of the vasopressin (AVP) precursor peptide, can be assayed as a surrogate for AVP. Copeptin shows prognostic potential in a range of inflammatory and cardiovascular conditions but its relationship with Tc has not been characterised.

Objective: To investigate the serum copeptin response to Tc changes during exercise in a hot environment.

Methods: 15 subjects from a British Army infantry battalion were studied on their sixth day in Kenya during a 4.5 h simulated combat assault exercise. Tc was recorded by telemetry from ingested pills every 60 s during the exercise. Serum copeptin was assayed pre- and post-exercise.

Results: Tc increased in 15/15 subjects. Average Tc (TcAv) was 37.36±0.21 °C. Change in plasma copeptin concentration (Δcopeptin) was positive in 13/15 subjects. Mean Δcopeptin was 6.67±5.83 pmol/l (P=0.0006). In eight subjects with maximum Tc (TcMax) >38 °C, mean Δcopeptin was more than 400% greater than for the seven subjects with TcMax <38 °C (10.40±4.34 pmol/l vs 2.40±4.2 pmol/l; P=0.0059). There was a strong positive correlation between TcAv and Δcopeptin (r=0.75, P<0.01).

Conclusions: Copeptin stratified military subjects relative to the critical thermal threshold of 38 °C. Copeptin may be a plausible biomarker of thermal strain and EHI risk in both military and civilian populations.

Disclosure: This work was supported by the Surgeon General, Headquarters Defence Medical Services and the Royal Navy Fleet Command

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