title: Stress hormones predict cerebrovascular re-events after transient ischemic attacks.
abstract: BACKGROUND
  TIA is a strong predictor of subsequent stroke. The hypothalamic stress hormone copeptin is an accurate prognostic marker in acute ischemic stroke. This study assessed prognostic reliability of 2 distinct stress hormones, copeptin and cortisol, for the risk stratification of re-events in patients with TIA.
  
  
  METHODS
  We conducted a prospective study in patients admitted to the emergency department with a TIA. Clinical risk scoring using the ABCD2 score was determined and both hormones were measured in plasma on admission. The primary endpoint was a cerebrovascular re-event within 90 days.
  
  
  RESULTS
  We included 107 consecutive patients with TIA. Re-events occurred in 10 patients (9%). Copeptin levels were higher in patients with a re-event compared with patients without re-event (p = 0.02), in contrast to cortisol (p = 0.53). Copeptin revealed a higher area under the receiver operating characteristics curve (AUC) to predict re-events compared to the ABCD2 score (AUC of 0.73 vs 0.43; p < 0.01) and improved its prognostic accuracy (AUC of combined model of 0.77; p = 0.002).
  
  
  CONCLUSIONS
  Measurement of plasma copeptin but not cortisol levels in patients with TIA provides additional prognostic information beyond the ABCD2 clinical risk score alone. If confirmed in future studies, routine copeptin measurement may be an additional tool for risk stratification and targeted resource allocation after TIA.
authors.affiliation: Department of Endocrinology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. mk3270@columbia.edu
authors.forename: M
authors.initials: M
authors.lastname: Katan
authors.forename: N
authors.initials: N
authors.lastname: Nigro
authors.forename: F
authors.initials: F
authors.lastname: Fluri
authors.forename: P
authors.initials: P
authors.lastname: Schuetz
authors.forename: N G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: F
authors.initials: F
authors.lastname: Jax
authors.forename: S
authors.initials: S
authors.lastname: Meckel
authors.forename: A
authors.initials: A
authors.lastname: Gass
authors.forename: R
authors.initials: R
authors.lastname: Bingisser
authors.forename: A
authors.initials: A
authors.lastname: Steck
authors.forename: L
authors.initials: L
authors.lastname: Kappos
authors.forename: S
authors.initials: S
authors.lastname: Engelter
authors.forename: B
authors.initials: B
authors.lastname: Müller
authors.forename: M
authors.initials: M
authors.lastname: Christ-Crain
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002561:Cerebrovascular Disorders / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D002546:Ischemic Attack, Transient / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000517:prevention & control
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins; D006854:Hydrocortisone