Copeptin: a novel, independent prognostic marker in patients with ischemic stroke.
OBJECTIVE
Early prediction of outcome in patients with ischemic stroke is important. Vasopressin is a stress hormone. Its production rate is mirrored in circulating levels of copeptin, a fragment of provasopressin. We evaluated the prognostic value of copeptin in acute stroke patients.


METHODS
In a prospective observational study, copeptin was measured using a new sandwich immunoassay on admission in plasma of 362 consecutive patients with an acute ischemic stroke. The prognostic value of copeptin to predict the functional outcome (defined as a modified Rankin Scale score of <or=2 or >or=3), mortality within 90 days, was compared with the National Institutes of Health Stroke Scale score and with other known outcome predictors.


RESULTS
Patients with an unfavorable outcomes and nonsurvivors had significantly increased copeptin levels on admission (p <0.0001 and p <0.0001). Receiver operating characteristics to predict functional outcome and mortality demonstrated areas under the curve of copeptin of 0.73 (95% confidence interval [CI], 0.67-0.78) and 0.82 (95% CI, 0.76-0.89), which was comparable with the National Institutes of Health Stroke Scale score but superior to C-reactive protein and glucose (p <0.01). In multivariate logistic regression analysis, copeptin was an independent predictor of functional outcome and mortality, and improved the prognostic accuracy of the National Institutes of Health Stroke Scale to predict functional outcome (combined areas under the curve, 0.79; 95% CI, 0.74-0.84; p <0.01) and mortality (combined areas under the curve, 0.89; 95% CI, 0.84-0.94; p <0.01).


CONCLUSIONS
Copeptin is a novel, independent prognostic marker improving currently used risk stratification of stroke patients. Ann Neurol 2009;66:799-808.
Katan
Mira
M
Department of Endocrinology, University Hospital Basel, Switzerland.
Fluri
Felix
F
Morgenthaler
Nils G
NG
Schuetz
Philipp
P
Zweifel
Christian
C
Bingisser
Roland
R
Müller
Klaus
K
Meckel
Stephan
S
Gass
Achim
A
Kappos
Ludwig
L
Steck
Andreas J
AJ
Engelter
Stefan T
ST
Müller
Beat
B
Christ-Crain
Mirjam
M
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002545:Brain Ischemia / Q000150:complications; D015331:Cohort Studies; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D013997:Time Factors
D006020:Glycopeptides; C048197:copeptins