The diagnostic and prognostic value of copeptin in patients with acute ischemic stroke and transient ischemic attack: A systematic review and meta-analysis

Abstract

Background Stroke is the second main cause of mortality and the third leading cause of mortality and permanent disability combined. Many potential biomarkers have been described to contribute to the diagnosis, prognosis of outcomes, and risk stratification after stroke. Copeptin is an inactive peptide that is produced in an equimolar ratio to arginine vasopressin in response to the activation of the endogenous stress system. Methods The present study is a systematic review and meta-analysis to assess plasma copeptin concentrations, diagnostic and prognostic values for risk stratification after acute ischemic stroke and transient ischemic attack. Results Mean copeptin level in stroke vs. non-stroke groups varied and amounted to 19.8 ± 17.4 vs. 9.7 ± 6.6 pmol/L, respectively (mean differences [MD]: 12.75; 95% confidence interval [CI]: 5.00 to 20.49; p < 0.001), in good vs. poor outcome 12.0 ± 3.6 vs. 29.4 ± 14.5 (MD: −8.13; 95% CI: −8.37 to −7.88; p < 0.001) and in survive vs. non-survive stroke patients: 13.4 ± 3.2 vs. 33.0 ± 12.3, respectively (MD: −13.43; 95% CI: −17.82 to −9.05; p < 0.001). Conclusions The above systematic review and meta-analysis suggests that monitoring the copeptin levels may help predict the long-term prognosis of ischemic stroke efficiently. Determining the copeptin level may help individualize the management of ischemic stroke patients, keep stroke risk lower, reduce post-stroke complications, including patient death, and minimize healthcare costs.

Copeptin as a Diagnostic and Prognostic Biomarker in Cardiovascular Diseases

“…It has been shown that cerebral ischemia may increase AVP levels in the plasma of patients with stroke ( 212 , 213 ) and that V1R, but not V2R, is involved in the pathophysiology of secondary brain damage after focal cerebral ischemia ( 214 ). A meta-analysis revealed mean copeptin levels in different groups: stroke and non-stroke groups (19.8 ± 17.4 vs. 9.7 ± 6.6 pmol/L, respectively), good vs. poor outcome groups (12.0 ± 3.6 vs. 29.4 ± 14.5 pmol/L, respectively), and survive vs. non-survive stroke patients (13.4 ± 3.2 vs. 33.0 ± 12.3, respectively) ( 215 ), suggesting copeptin may guide the management of stroke patients. Interestingly, no significant difference was observed between the stroke group and stroke mimics (diseases with symptoms frequently seen in patients with stroke but caused by non-cerebrovascular pathogeneses) groups ( 216 ), indicating that copeptin could not discriminate between stroke and stroke mimics.…”

Evaluating Serum Copeptin as a Promising Biomarker for Predicting Acute Ischaemic Stroke Severity: A Hospital-Based Study on Strokes

“…AVP release stimulates V1a and V2 receptors, which then cause platelet aggregation, vasoconstriction, and water retention with low plasma osmolality and hypovolemic or euvolemic hyponatraemia as consequences with resultant infarct volume expansion. This is the first study we are aware of that looked into the relationship between copeptin level, ischaemic stroke severity, and infarct volume in the country [ 22 , 33 , 34 ].…”

Biomarkers and the outcomes of ischemic stroke

“…A glycopeptide of 39 amino acids, copeptin is a fragment of the prohormone pre-pro-vasopressin, which is a precursor to vasopressin. Inside the posterior pituitary gland, pre-pro-vasopressin is cleaved into copeptin and vasopressin, which are circulating in equimolar amounts ( Blek et al, 2022 ). The serum copeptin level is a marker of vasopressin secretion due to its high stability, and reflects the degree of activation of hypothalamic–pituitary–adrenal-axis in IS patients ( Jalleh and Torpy, 2021 ).…”