title: Risk stratification in emergency patients by copeptin.
abstract: BACKGROUND
  Rapid risk stratification is a core task in emergency medicine. Identifying patients at high and low risk shortly after admission could help clinical decision-making regarding treatment, level of observation, allocation of resources and post discharge follow-up. The purpose of the present study was to determine short-, mid- and long-term mortality by plasma measurement of copeptin in unselected admitted patients.
  
  
  METHODS
  Consecutive patients >40-years-old admitted to an inner-city hospital were included. Within the first 24 hours after admission, a structured medical interview was conducted and self-reported medical history was recorded. All patients underwent a clinical examination, an echocardiographic evaluation and collection of blood for later measurement of risk markers.
  
  
  RESULTS
  Plasma for copeptin measurement was available from 1,320 patients (average age 70.5 years, 59.4% women). Median follow-up time was 11.5 years (range 11.0 to 12.0 years). Copeptin was elevated (that is, above the 97.5 percentile in healthy individuals).Mortality within the first week was 2.7% (17/627) for patients with elevated copeptin (above the 97.5 percentile, that is, >11.3 pmol/L) compared to 0.1% (1/693) for patients with normal copeptin concentrations (that is, ≤11.3 pmol/L) (P <0.01). Three-month mortality was 14.5% (91/627) for patients with elevated copeptin compared to 3.2% (22/693) for patients with normal copeptin. Similar figures for one-year mortality and for the entire observation period were 27.6% (173/627) versus 8.7% (60/693) and 82.9% (520/527) versus 57.5% (398/693) (P <0.01 for both), respectively.Using multivariable Cox regression analyses shows that elevated copeptin was significantly and independently related to short-, mid- and long-term mortality. Adjusted hazard ratios were 2.4 for three-month mortality, 1.9 for one-year mortality and 1.4 for mortality in the entire observation period.
  
  
  CONCLUSIONS
  In patients admitted to an inner-city hospital, copeptin was strongly associated with short-, mid- and long-term mortality. The results suggest that rapid copeptin measurement could be a useful tool for both disposition in an emergency department and for mid- and long-term risk assessment.
authors.affiliation: Departments of Cardiology and Endocrinology, Hillerød Hospital, Hillerød, Denmark. kasper.iversen@dadlnet.dk.
authors.forename: Kasper
authors.initials: K
authors.lastname: Iversen
authors.forename: Jens P
authors.initials: JP
authors.lastname: Gøtze
authors.forename: Morten
authors.initials: M
authors.lastname: Dalsgaard
authors.forename: Henrik
authors.initials: H
authors.lastname: Nielsen
authors.forename: Søren
authors.initials: S
authors.lastname: Boesgaard
authors.forename: Morten
authors.initials: M
authors.lastname: Bay
authors.forename: Vibeke
authors.initials: V
authors.lastname: Kirk
authors.forename: Olav W
authors.initials: OW
authors.lastname: Nielsen
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009026:Mortality; D012044:Regression Analysis; D012306:Risk; D018570:Risk Assessment / Q000379:methods*; D014218:Triage / Q000379:methods*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins