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Copeptin for the prediction of recurrent cerebrovascular events after transient ischemic attack: results from the
Gian Marco De Marchis1, Anja Weck1, Heinrich Audebert1
1From the Departments of Neurology and Clinical Chemistry, Inselspital, University of Bern, Bern, Switzerland (G.M.D.M., A.W., D.B., S.J., H.P.M., M.A.); Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY (G.M.D.M.); Department of Neurology (G.M.D.M.) and Department of Endocrinology (M.C.-C.), University Hospital of Basel, Basel, Switzerland; Departments of Neurology (H.A., S.B.) and Endocrinology (N.G.M.), Charité, Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Goethe University, Frankfurt am Main, Germany (C.F.); Medical University Department, Kantonsspital Aarau, Aarau, Switzerland (P.S., B.M.); Thermo Fisher Scientific Clinical Diagnostics BRAHMS GmbH, Hennigsdorf-Berlin, Germany (M.S.); and Department of Neurology, University Hospital of Zurich, Zurich, Switzerland (M.K.).
Background And Purpose:
Copeptin has been associated with recurrent cerebrovascular events after transient ischemic attack (TIA). In an independent cohort, we evaluated copeptin for the prediction of recurrent cerebrovascular events within 3 months after TIA and assessed the incremental value of copeptin compared with the ABCD2 (age, blood, clinical features of TIA, duration of symptoms, presence of diabetes mellitus) and ABCD3-I (ABCD2, dual TIA [the presence of ≥2 TIA symptoms within 7 days], imaging [the presence of abnormal findings on neuroimaging]) scores.
Methods:
This prospective, multicenter cohort study was conducted at 3 tertiary Stroke Centers in Switzerland and Germany.
Results:
From March 2009 through April 2011, we included 302 patients with TIA admitted within 24 hours from symptom onset. Of 28 patients with a recurrent cerebrovascular event within 3 months (stroke or TIA), 11 patients had a stroke. Although the association of copeptin with recurrent cerebrovascular events was not significant, the association with stroke alone as end point was significant. After adjusting for the ABCD2 score, a 10-fold increase in copeptin levels was associated with an odds ratio for stroke of 3.39 (95% confidence interval, 1.28-8.96; P=0.01). After addition of copeptin to the ABCD2 score, the area under the curve of the ABCD2 score improved from 0.60 (95% confidence interval, 0.46-0.74) to 0.74 (95% confidence interval, 0.60-0.88, P=0.02). In patients with MRI (n=223), the area under the curve of the ABCD3-I score increased in similar magnitude, although not significantly. Based on copeptin, 31.2% of patients were correctly reclassified across the risk categories of the ABCD2 score (net reclassification improvement; P=0.17).
Conclusions:
Copeptin improved the prognostic value of the ABCD2 score for the prediction of stroke but not TIA, and it may help clinicians in refining risk stratification for patients with TIA.
Clinical Trial Registration Url:
http://www.clinicaltrials.gov. Unique identifier: NCT00878813.
