title: Copeptin: Limited Usefulness in Early Stroke Differentiation?
abstract: Background. Stroke can be a challenging diagnosis in an emergency-setting. We sought to determine whether copeptin may be a useful biomarker to differentiate between ischemic stroke (IS), transient ischemic attack (TIA), and stroke-mimics. Methods. In patients with suspected stroke arriving within 4.5 hours of symptom-onset, copeptin-levels were measured in initial blood-samples. The final diagnosis was adjudicated by vascular neurologists blinded to copeptin-values. Results. Of all 36 patients with available copeptin-values (median age 71 years, IQR: 54-76; 44% female), 20 patients (56%) were diagnosed with IS, no patient was diagnosed with hemorrhagic stroke, nine patients (25%) were diagnosed with TIA, and seven patients (19%) were stroke-mimics. Copeptin-levels (in pmol/L) tended to be higher in patients with IS [19.1 (11.2-48.5)] compared to TIA [9.4 (5.4-13.8)]. In stroke-mimics the range of values was extremely broad [33.3 (7.57-255.7)]. The diagnostic accuracy of copeptin for IS was 63% with a sensitivity of 80% and a positive predictive value of 64%. Conclusion. In this cohort of patients copeptin-levels within 4.5 hours of symptom onset were higher in patients with IS compared to TIA but the broad range of values in stroke-mimics limits diagnostic accuracy. This trial is registered with UTN: U1111-1119-7602.
authors.affiliation: Division of Emergency Medicine, Department of Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: von Recum
authors.affiliation: Division of Emergency Medicine, Department of Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Searle
authors.affiliation: Division of Emergency Medicine, Department of Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Slagman
authors.affiliation: B.R.A.H.M.S GmbH, Thermo Scientific Clinical Diagnostics, 16761 Hennigsdorf, Germany.
authors.forename: Jörn Ole
authors.initials: JO
authors.lastname: Vollert
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany ; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany ; German Center for Neurodegenerative Diseases (DZNE), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany ; German Centre for Cardiovascular Research (DZHK), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.affiliation: Division of Emergency Medicine, Department of Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany ; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Ebinger