title: Predictive value of S100-B and copeptin for outcomes following seizure: the BISTRO International Cohort Study.
abstract: OBJECTIVE
  To evaluate the performance of S100-B protein and copeptin, in addition to clinical variables, in predicting outcomes of patients attending the emergency department (ED) following a seizure.
  
  
  METHODS
  We prospectively included adult patients presented with an acute seizure, in four EDs in France and the United Kingdom. Participants were followed up for 28 days. The primary endpoint was a composite of seizure recurrence, all-cause mortality, hospitalization or rehospitalisation, or return visit in the ED within seven days.
  
  
  RESULTS
  Among the 389 participants included in the analysis, 156 (40%) experienced the primary endpoint within seven days and 195 (54%) at 28 days. Mean levels of both S100-B (0.11 μg/l [95% CI 0.07-0.20] vs 0.09 μg/l [0.07-0.14]) and copeptin (23 pmol/l [9-104] vs 17 pmol/l [8-43]) were higher in participants meeting the primary endpoint. However, both biomarkers were poorly predictive of the primary outcome with a respective area under the receiving operator characteristic curve of 0.57 [0.51-0.64] and 0.59 [0.54-0.64]. Multivariable logistic regression analysis identified higher age (odds ratio [OR] 1.3 per decade [1.1-1.5]), provoked seizure (OR 4.93 [2.5-9.8]), complex partial seizure (OR 4.09 [1.8-9.1]) and first seizure (OR 1.83 [1.1-3.0]) as independent predictors of the primary outcome. A second regression analysis including the biomarkers showed no additional predictive benefit (S100-B OR 3.89 [0.80-18.9] copeptin OR 1 [1.00-1.00]).
  
  
  CONCLUSIONS
  The plasma biomarkers S100-B and copeptin did not improve prediction of poor outcome following seizure. Higher age, a first seizure, a provoked seizure and a partial complex seizure are independently associated with adverse outcomes.
authors: Sorbonne universités, UPMC Univ Paris 06, UMRS INSERM 1166, IHU ICAN, Paris, France; Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
authors: Yonathan
authors: Y
authors: Freund
authors: Emergency Department, Royal London Hospital, London, United Kingdom; Queen Mary University of London, London, United Kingdom.
authors: Benjamin
authors: B
authors: Bloom
authors: Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
authors: Jerome
authors: J
authors: Bokobza
authors: Emergency Department, Hôpital Tenon, APHP, Paris, France.
authors: Nacera
authors: N
authors: Baarir
authors: Emergency Department, Hôpital Lariboisière, APHP, Paris, France.
authors: Said
authors: S
authors: Laribi
authors: Emergency Department, Royal London Hospital, London, United Kingdom; Queen Mary University of London, London, United Kingdom.
authors: Tim
authors: T
authors: Harris
authors: Neurology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France.
authors: Vincent
authors: V
authors: Navarro
authors: Biochemistry Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France; Université Paris 5 Paris Cité, Paris, France.
authors: Maguy
authors: M
authors: Bernard
authors: Adult critical care unit, Royal London Hospital, London, United Kingdom; Queen Mary University of London, London, United Kingdom.
authors: Rupert
authors: R
authors: Pearse
authors: Sorbonne universités, UPMC Univ Paris 06, UMRS INSERM 1166, IHU ICAN, Paris, France; Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
authors: Bruno
authors: B
authors: Riou
authors: Sorbonne universités, UPMC Univ Paris 06, UMRS INSERM 1166, IHU ICAN, Paris, France; Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
authors: Pierre
authors: P
authors: Hausfater
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D023381:Endpoint Determination; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006760:Hospitalization; D006801:Humans; D038622:Internationality; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*; D012640:Seizures / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy
chemical_list: D006020:Glycopeptides; D064568:S100 Calcium Binding Protein beta Subunit; C048197:copeptins