title: Copeptin Levels in Patients With Acute Ischemic Stroke and Stroke Mimics.
abstract: OBJECTIVE
  Copeptin levels are increased in patients diagnosed with stroke and other vascular diseases. Copeptin elevation is associated with adverse outcome, predicts re-events in patients with transient ischemic attack and is used in ruling-out acute myocardial infarction. We evaluated whether copeptin can also be used as a diagnostic marker in the prehospital stroke setting.
  
  
  METHODS
  We prospectively examined patients with suspected stroke on the Stroke Emergency Mobile-an ambulance that is equipped with computed tomography and point-of-care laboratory. A blood sample was taken from patients immediately after arrival. We analyzed copeptin levels in patients with final hospital-based diagnosis of stroke or stroke mimics as well as in vascular or nonvascular patients. In addition, we examined the associations of symptom onset with copeptin levels and the prognostic value of copeptin in patients with stroke.
  
  
  RESULTS
  Blood samples of 561 patients were analyzed. No significant differences were seen neither between cerebrovascular (n=383) and other neurological (stroke mimic; n=90) patients (P=0.15) nor between vascular (n=391) and nonvascular patients (n=170; P=0.57). We could not detect a relationship between copeptin levels and time from onset to blood draw. Three-month survival status was available in 159 patients with ischemic stroke. Copeptin levels in nonsurviving patients (n=8: median [interquartile range], 27.4 [20.2-54.7] pmol/L) were significantly higher than in surviving patients (n=151: median [interquartile range], 11.7 [5.2-30.9] pmol/L; P=0.024).
  
  
  CONCLUSIONS
  In the prehospital setting, copeptin is neither appropriate to discriminate between stroke and stroke mimic patients nor between vascular and nonvascular patients.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01382862. The Pre-Hospital Acute Neurological Therapy and Optimization of Medical Care in Stroke Patients study (PHANTOM-S) was registered (NCT01382862). This sub-study was observational and not registered separately, therefore.
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.). matthias.wendt@charite.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wendt
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Martin
authors.initials: M
authors.lastname: Ebinger
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Kunz
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Michal
authors.initials: M
authors.lastname: Rozanski
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Carolin
authors.initials: C
authors.lastname: Waldschmidt
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Weber
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Benjamin
authors.initials: B
authors.lastname: Winter
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Peter M
authors.initials: PM
authors.lastname: Koch
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Sabine
authors.initials: S
authors.lastname: Hertel
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Tim
authors.initials: T
authors.lastname: Ziera
authors.affiliation: From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Audebert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood*; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D020521:Stroke / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; C048197:copeptins
keywords: biomarkers; copeptin; myocardial infarction; stroke; vascular diseases