Copeptin is associated with mortality and outcome in patients with acute intracerebral hemorrhage

被引:69
作者
Zweifel, Christian [2 ]
Katan, Mira [1 ,3 ]
Schuetz, Philipp [1 ]
Siegemund, Martin [4 ]
Morgenthaler, Nils G. [5 ]
Merlo, Adrian [2 ]
Mueller, Beat [1 ,6 ]
Christ-Crain, Mirjam [1 ]
机构
[1] Univ Basel Hosp, Dept Endocrinol & Clin Nutr, CH-4031 Basel, Switzerland
[2] Univ Basel Hosp, Dept Neurosurg, CH-4031 Basel, Switzerland
[3] Univ Basel Hosp, Dept Neurol, CH-4031 Basel, Switzerland
[4] Univ Basel Hosp, Dept Anesthesia, Operat Intens Care Unit, CH-4031 Basel, Switzerland
[5] Ctr Biotechnol, BRAHMS Aktiengesell, Dept Res, D-16761 Hennigsdorf, Germany
[6] Dept Internal Med, CH-5001 Aarau, Switzerland
来源
BMC NEUROLOGY | 2010年 / 10卷
基金
瑞士国家科学基金会;
关键词
CORTICOTROPIN-RELEASING HORMONE; TRAUMATIC BRAIN-INJURY; VASOPRESSIN PRECURSOR; STABLE PEPTIDE; REGULATORY MECHANISMS; ANTIDIURETIC-HORMONE; PROGNOSTIC MARKER; CEREBRAL-ISCHEMIA; GRADING SCALE; V-2; RECEPTORS;
D O I
10.1186/1471-2377-10-34
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Spontaneous intracerebral hemorrhage (ICH) accounts for a high mortality and morbidity. Early prediction of outcome is crucial for optimized care and treatment decision. Copeptin, the C-terminal part of provasopressin, has emerged as a new prognostic marker in a variety of diseases, but its prognostic value in ICH is unknown. Methods: In 40 consecutive patients who were admitted to the hospital within 72 hours after a spontaneous ICH, the plasma copeptin level was measured with a sandwich immunoassay upon admission. The prognostic value of copeptin to predict 30 day mortality and functional outcome after 90 days was assessed. A favorable outcome was defined as a Barthel score above 85 and a score below 3 on the Modified Rankin Scale. Results: Copeptin correlated positively with hematoma volume (r = 0.32, p < 0.05) and negatively with the Glasgow Coma Scale (GCS) on admission (r = -0.35, p < 0.05). Copeptin levels were higher in patients who died within 30 days than in 30-day survivors (179.0 pmol/l (IQR 33.7-566.0) vs. 12.9 pmol/l (IQR 5.2-42.8), p = 0.003). Copeptin levels were also higher in patients with an unfavorable functional outcome at 90 days compared to patients with a favorable outcome (32.4 pmol/l (IQR 9.5-97.8) vs. 11.9 pmol/l (IQR 3.2-19.8), p = 0.04). For the prediction of death, receiver-operating-characteristics analysis revealed an area under the curve (AUC) for copeptin of 0.88 (95% CI 0.75-1.00). The predictive value of the copeptin concentration was thus similar to that of GCS (AUC 0.82 (95% CI 0.59-1.00) p = 0.53), of the ICH Score (AUC 0.89, (95% CI 0.76-1.00), p = 0.94) and the ICH Grading Scale (AUC 0.86 (95% CI 0.69-1.00), p = 0.81). Conclusions: Copeptin is a new prognostic marker in patients with an ICH. If this finding can be confirmed in larger studies, copeptin might be an additional valuable tool for risk stratification and decision-making in the acute phase of ICH.
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