Copeptin: A novel, independent prognostic marker in patients with ischemic stroke

Katan, Mira; Fluri, Felix; Morgenthaler, Nils G.; Schuetz, Philipp; Zweifel, Christian; Bingisser, Roland; Müller, Klaus; Meckel, Stephan; Gass, Achim; Kappos, Ludwig; Steck, Andreas; Engelter, Stefan T.; Müller, Beat; Christ‐Crain, Mirjam

doi:10.1002/ana.21783

Cited by 251 publications

(243 citation statements)

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“…19 Moreover, copeptin improved reclassification compared to the multivariate models including demographic factors, cardiovascular risk factors, lesion size in MR, comorbidities, and admission laboratory variables such as CRP and glucose. The CoRisk study confirms and extends the conclusions of the previously published derivation study 3 . Further new findings are that (1) copeptin independently predicts complications, and (2) the prognostic ability of copeptin was consistent across subgroups including different acute treatments (conservative vs. thrombolysis).…”

Section: Discussionsupporting

confidence: 89%

“…We pre-specified that models were adjusted for NIHSS, age, and lesion size, modified Charlson Index 13 and Total Anterior Circulation Stroke (TACS) 10 based on the results of the previous derivation study. 3 In addition, the final multivariate models included variables significantly associated with an unfavorable outcome or mortality in the univariate analyses. As patients with severe stroke tend to present earlier, time from symptom onset to blood collection was included in the final model.…”

Section: Multivariate Regression Modelsmentioning

confidence: 99%

“…1,2 However, a recent single-center study showed that copeptin, a hypothalamic hormone derived from the precursor of vasopressin, predicted outcome and mortality three months and one year after ischemic stroke, improving the prognostic accuracy of established predictors. 3,4 Copeptin is a reliable prognostic marker not only in stroke patients but also in patients with cardiovascular events. 5,6 However, before implementing copeptin in clinical practice, the prognostic potential of copeptin needs to be validated in a prospective, independent, large multicenter study.…”

Section: Introductionmentioning

confidence: 99%

“…The lesion size was calculated by a commonly used semi-quantitative method validated for ischemic stroke lesions. 11 Lesions were categorized into three size classes to represent typical stroke patterns: i) small lesion with a volume of < 10 mm 3 , ii) medium lesion of 10-100 mm 3 , iii) large lesion with a volume of more than 100 mm 3 . 3 Detailed information such as cardiac and neurovascular ultrasound and 24-hour ECGs were collected to define stroke etiology according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification.…”

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confidence: 99%

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Copeptin adds prognostic information after ischemic stroke

et al. 2013

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OBJECTIVE: To evaluate and validate the incremental value of copeptin in the prediction of outcome and complications as compared with established clinical variables. METHODS: In this prospective, multicenter, cohort study, we measured copeptin in the emergency room within 24 hours from symptom onset in 783 patients with acute ischemic stroke. The 2 primary end points were unfavorable functional outcome (modified Rankin Scale score 3-6) and mortality within 90 days. Secondary end points were any of 5 prespecified complications during hospitalization. RESULTS: In multivariate analysis, higher copeptin independently predicted unfavorable outcome (adjusted odds ratio 2.17 for any 10-fold copeptin increase [95% confidence interval CI, 1.46-3.22], p < 0.001), mortality (adjusted hazard ratio 2.40 for any 10-fold copeptin increase [95% CI, 1.60-3.60], p < 0.001), and complications (adjusted odds ratio 1.93 for any 10-fold copeptin increase [95% CI, 1.33-2.80], p = 0.001). The discriminatory accuracy, calculated with the area under the receiver operating characteristic curve, improved significantly for all end points when adding copeptin to the NIH Stroke Scale score and the multivariate models. Moreover, the combination of copeptin with a validated score encompassing both the NIH Stroke Scale and age led to a net reclassification improvement of 11.8% for functional outcome and of 37.2% for mortality. CONCLUSIONS: In patients with ischemic stroke, copeptin is a validated blood marker that adds predictive information for functional outcome and mortality at 3 months beyond stroke severity and age. Copeptin seems to be a promising new blood marker for prediction of in-hospital complications. Authors Contribution:As principal investigators, Dr De Marchis (GMDM), Dr Katan (MK) and Dr Arnold (MA) had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Methods:In this prospective, multicenter cohort study we measured copeptin in the emergency room within 24 hours from symptom onset in 783 patients with acute ischemic stroke. The two primary endpoints were unfavorable functional outcome (modified Rankin Scale score 3-6) and mortality within 90 days. Secondary endpoints were any of five prespecified complications during hospitalization.

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Section: Discussionsupporting

confidence: 89%

Section: Multivariate Regression Modelsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Copeptin adds prognostic information after ischemic stroke

et al. 2013

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“…In children with septic shock, vasopressin and copeptin levels may not robust markers for severity and clinical outcomes [14]. Copeptin is also increased in several acute neurological illnesses, such as acute ischemic stroke [15,16], spontaneous cerebral hemorrhage [17][18][19] and brain trauma [20]. Copeptin, measured within the first 24 h after stroke onset, improves neurologic prognostication after ischemic stroke adding predictive information for functional outcome and mortality at 3 months beyond age and stroke severity measured with the NIH Stroke Scale score [16].…”

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confidence: 99%

Copeptin in critical illness

Latronico¹,

Castioni²

2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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Evolving role of biomarkers in acute cerebrovascular disease

Kernagis

Laskowitz

2012

Annals of Neurology

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The development of a clinically validated biomarker of acute cerebral ischemia would have the potential to facilitate the use of time-sensitive reperfusion strategies, allow for individualization of patient care by predicting relative risk of hemorrhage and volume of penumbral tissue, and add valuable prognostic information for patients presenting with acute stroke. Additionally, a stroke biomarker might benefit early stage clinical research by serving as a surrogate measure of ischemic injury. Although at present there are no clinically validated biomarkers of acute stroke, previous studies have focused on markers associated with different components of the ischemic cascade, including microglial activation, inflammation, oxidative stress, neuronal injury, hemostasis, and endothelial dysfunction. Evolving technologies have provided high throughput approaches to investigate potential gene and protein signatures, and methods to measure newly discovered markers of cell death and immune responses. Prior to defining the clinical utility of stroke biomarkers, it is critical to understand the inherent limitations of a biomarker-based approach and define its potential value for providing adjunctive diagnostic and prognostic information. The identification and validation of a clinically relevant biomarker, or panel of markers, of stroke will ultimately require incorporation of both stringent research design and assessment in the clinical context in which the marker will be used.

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Copeptin: A novel, independent prognostic marker in patients with ischemic stroke

Abstract: Copeptin is a novel, independent prognostic marker improving currently used risk stratification of stroke patients. Ann Neurol 2009;66:799-808.

Cited by 251 publications

References 50 publications

Copeptin adds prognostic information after ischemic stroke

Copeptin adds prognostic information after ischemic stroke

Copeptin in critical illness

Evolving role of biomarkers in acute cerebrovascular disease

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