Copeptin as a serum biomarker of febrile seizures
Benjamin Stöcklin1, Sotirios Fouzas2, Paula Schillinger1
1Division of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital (UKBB), Basel, Switzerland.
Insights
Serum copeptin levels are significantly elevated in children experiencing febrile seizures (FS). This biomarker shows high diagnostic accuracy, aiding in the emergency diagnosis of postictal states in children.
Area of Science:
- Pediatric Neurology
- Biomarkers in Medicine
- Emergency Medicine
Background:
- Accurate diagnosis of febrile seizures (FS) in children is challenging due to the absence of reliable postictal biomarkers.
- Serum copeptin, a marker of arginine vasopressin secretion, is investigated as a potential diagnostic tool.
Purpose of the Study:
- To determine if serum copeptin levels are elevated in children with febrile seizures.
- To assess the diagnostic accuracy of serum copeptin for febrile seizures.
Main Methods:
- A prospective cross-sectional study involving 161 children (6 months to 5 years) was conducted in an emergency setting.
- Serum copeptin and prolactin levels were measured in children with febrile seizures (n=83), febrile infection without seizures (n=69), and non-febrile epileptic seizures (n=9).
Main Results:
- Serum copeptin was significantly higher in children with febrile seizures compared to febrile controls (p < 0.001).
- Seizures were the primary determinant of serum copeptin levels (beta 0.509; p < 0.001).
- Copeptin demonstrated superior diagnostic accuracy (AUC 0.824) compared to prolactin (AUC 0.667), with accuracy increasing as the time since seizure decreased.
Conclusions:
- Circulating copeptin exhibits high diagnostic accuracy for febrile seizures.
- Serum copeptin may serve as a valuable adjunct biomarker for diagnosing postictal states in emergency settings.
Background And Objectives:
Accurate diagnosis of febrile seizures in children presenting after paroxysmal episodes associated with fever, is hampered by the lack of objective postictal biomarkers. The aim of our study was to investigate whether FS are associated with increased levels of serum copeptin, a robust marker of arginine vasopressin secretion.
Methods:
This was a prospective emergency-setting cross-sectional study of 161 children between six months and five years of age. Of these, 83 were diagnosed with febrile seizures, 69 had a febrile infection without seizures and nine had epileptic seizures not triggered by infection. Serum copeptin and prolactin levels were measured in addition to standard clinical, neurophysiological, and laboratory assessment.
Clinical Trial Registration:
NCT01884766.
Results:
Circulating copeptin was significantly higher in children with febrile seizures (median [interquartile range] 18.9 pmol/L [8.5-36.6]) compared to febrile controls (5.6 pmol/L [4.1-9.4]; p < 0.001), with no differences between febrile and epileptic seizures (21.4 pmol/L [16.1-46.6]; p = 0.728). In a multivariable regression model, seizures were the major determinant of serum copeptin (beta 0.509; p < 0.001), independently of clinical and baseline laboratory indices. The area under the receiver operating curve for copeptin was 0.824 (95% CI 0.753-0.881), significantly higher compared to prolactin (0.667 [0.585-0.742]; p < 0.001). The diagnostic accuracy of copeptin increased with decreasing time elapsed since the convulsive event (at 120 min: 0.879 [0.806-0.932] and at <60 min: 0.975 [0.913-0.997]).
Conclusions:
Circulating copeptin has high diagnostic accuracy in febrile seizures and may be a useful adjunct for accurately diagnosing postictal states in the emergency setting.
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