Evaluation of Serum Copeptin and Psychological Stress Level Among Healthcare Providers During COVID-19 Pandemic
Conditions: Psychological Stress, Hemostatic Disorder
Sponsor: Alexandria University

 
 
 
Evaluation of Serum Copeptin and Psychological Stress Level Among Healthcare 
Providers During COVID-19 Pandemic 
 
 
 
Serial no: 0304842 
 
 
 
15/10/2020 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
Evaluation of Serum Copeptin and Psychological Stress Level Among Healthcare Providers 
During COVID-19 Pandemic.
 
 
                                   Hala Mourad Demerdash1, Eman O Khalil2, Emad A Arida2 
Department of Clinical Pathology Alexandria University Hospitals; Department of Anesthesia & 
Intensive Care, Alexandria University Faculty of Medicine. 
 
     The (COVID-19) pandemic created a remarkable impact on healthcare providers both 
physically and psychologically.  Perceived psychological stress (PSS) influences the homeostatic 
equilibrium, involving activation of the sympathetic nervous system and hypothalamus pituitary 
adrenal (HPA) axis. Copeptin; C-terminal portion of Vasopressin (AVP) precursor is stable, 
however, Evidence about impact of PSS on copeptin levels is lacking, 
 Aim: of this study was to estimate the influence of psychological stress on copeptin levels 
among healthcare providers working in ICU.  
Methods: A total of 70 healthcare volunteers participated in this prospective study; 35 
physicians (28 males and 7 females) and 35 nurses (10 males and 25 females). Fasting blood 
samples were withdrawn at 9:00 am for determination of copeptin, cortisol, insulin at three 
points; baseline prior onset of duty shifts in ICU. Second point at end of first week and third 
point was two weeks’ after leave taking. A questionnaire was conducted to all participants to 
assess stress (PSS). Cortisol was determined by a chemiluminescence immunoassay while 
insulin and Copeptin were measured by ELISA. 
Results: Baseline copeptin level was 15.76 ± 8.6 pmol/l significantly increased and was 
positively correlated with moderate stress PSS score was 29.4 ± 3.4. At second point, Copeptin 
level was significantly reduced 8.45 ±3.54 pmol/l. and third point, copeptin level was 3.98±1.28 
pmol/l and PSS score14± 3.43 relieved stress. At conclusion, positive correlation between serum 
copeptin, PSS, systolic blood pressure, serum insulin and body mass index. On the other hand, 
there was no significant difference between serum cortisol level during 3 measurements.  
Conclusion: finding suggest that copeptin may be used a potential biomarker for physiological 
strain during work in a stressful environment. 
Study design 
 
CONSORT 2010 Flow Diagram 
 
 
 
 
Assessed for eligibility 
Study group n=65, control group n=25 
Excluded  (n= 5  ) 
   Not meeting inclusion criteria (n=  ) 
   Declined to participate (n= 5 ) 
Enrollment 

 
 
 
 
 
 
Recruitment  
Group one; (studied group)70 healthcare personnel volunteers participated; worked at 
Intensive Care Units at Alexandria Quarantine Hospitals.  
Group two; (control group)25 healthcare personnel volunteers participated; not work in 
quarantine hospitals of matched same age, body mass index BMI, healthy not diabetic, no 
hypertension  
Pre-assignment Details  
group one ; healthcare providers worked in ICU: 35 physicians (28 males and 7 females) and 35 
nurses (10 males and 25 females). All volunteers were in good physical health Exclusion criteria 
included hypertension, diabetes mellitus, obesity BMI ≥30, subjects with serum sodium ≤135 or 
≥ 145 mmol /L at baseline or females receiving contraceptive pills.  
Assigned participants were clinically evaluated for as hypertension, DM, dyslipidemia, renal 
function. 
Then were given a questionnaire to assess the perceived psychological stress. 
 
Group Information   
one group of participants healthcare providers designated to take duty shifts at  
ICU in Alexandria quarantine hospitals for two weeks during COVID-19 pandemic were assigned 
according to their will to participate in study. And a control group of healthcare providers not 
assigned to work in quarantine hospitals.  
Period of evaluation: 
First assembly: for clinical assessment of participants, determine BMI and blood pressure, take 
questionnaire and withdrawal of serum blood sample one day before enrolling to work in ICU. 
Second assembly: at the end of first week after work in ICU take another blood sample 
Third assembly: two weeks after departure from work in ICU for revaluation of participants, 
determine BMI and blood pressure, and withdrawal of a serum blood sample 
 
Number of participants at initiating the period of study. 
They were 70 healthcare providers (doctors and nurses). 
Number of participants at the end of the period of study. 
They were 65 participants; 5 healthcare providers withdraw from study as they didn’t come 
during follow up in the third assembly two weeks after departure from ICU. 

 
Participants 35 physicians (28 males and 7 females) and 35 nurses (10 males and 25 females), 
Age ranged from 24 to 37 years with a median of 31 years. 
 
Table 1: Baseline clinical characteristics and metabolic variables of studied groups. 
 
 
Healthcare providers 
served at ICU 
(n=70) 
Control group  
(n=30) 
P value  
Sex (M/F)   
(38/32)  
(16/14)  
 
BMI (Kg/m2) 
24.28±2.54 
26.23±2.27 
0.231 
Systolic BP (mmHg) 
137±9.3 
136.7±8.4 
0.145 
Diastolic BP (mmHg) 
82.5 ± 6.4 
79.5 ± 7.3 
0.168 
Heart rate beats/min 
72 ± 5 
68± 6 
0.098 
FBG (mg/dl) 
91.5 ± 13.54 
92.62 ± 12.77 
0.425 
S. sodium (mmol/L) 
140.4 ± 5.23 
138.78±4.95 
0.311 
Total cholesterol 
(mg/dl) 
191.2 ± 23.5 
187.45±24.67 
0.207 
Plasma 
Copeptin(pmol/l) 
15.76 ± 8.6 
4.18±1.54 
0.001* 
S. cortisol  (nmol/L) 
501.7(348.4-675.4) 
488(332.62-612.23) 
0.138 
Data are means ± SE or n (%). *P < 0.05. 
Outcome measures: 
Primarily outcome: First determination of psychological stress among doctors and nurses 
working in ICU through a questionnaire before duty shifts [first time] and re-evaluate it after 
one week of work in ICU [second time], and lastly two weeks after departure from shift duties 
[third time].   
Second to determine stress hormones copeptin and cortisol (possible stress biomarkers) 
concurrently with questionnaire. 
Secondary outcome: correlate the level of psychological stress calculated from provided 
questionnaire in the three assemblies with stress biomarkers copeptin and cortisol in the three 
measurements.  
Time frame:  four weeks for each participant. 
Follow-up and outcome parameters: 
    All studied healthcare providers will be followed up before start of duty shifts, one week after 
work and two weeks from departure from duty shifts. They will be appraised every assembly for 
psychological stress level; before start of duty shifts (first time), one week after start (second 

time) and two weeks after departure from shift duties in ICU (third time) for assessment of 
psychological stress level and stress hormones. 
 
 
Biochemical parameters 
 
   Fasting blood samples will be collected from healthcare providers prior to start of duty shifts 
and two weeks after leave taking, after overnight fast and divided into two tubes; EDTA for 
complete blood count, the rest into plastic tubes and serum sample.  
  Serum glucose and Total cholesterol, urea, creatinine, serum sodium and potassium. 
   Serum cortisol and copeptin.  
 
 
Statistical analysis 
     
    All data will be analyzed with Statistical Package for the Social Sciences version 20 software 
(SPSS, Inc., Chicago, IL). Results will be displayed as mean ± SD. Paired Student’s t-test used to 
compare the data pre-operative and nine months postoperative. The chi-squared test used for 
category variables. Spearman correlation coefficient used to detect the correlation between 
different variables. Statistical correlations calculated by Pearson’s correlation test. P < 0.05 is 
considered significant.  
 
 
 
Dr Hala Demerdash  
Consultant Clinical Pathology at Alexandria University Hospitals 
Alexandria University, Faculty of Medicine Alexandria University Hospitals  
Mobile Telephone: +01229501257 
Faculty contact no: +201287740750 
Email: demerdashh@yahoo.com