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Abstract
Objective: To evaluate and validate the incremental value of copeptin in the prediction of outcome and complications as compared with established clinical variables.
Methods: In this prospective, multicenter, cohort study, we measured copeptin in the emergency room within 24 hours from symptom onset in 783 patients with acute ischemic stroke. The 2 primary end points were unfavorable functional outcome (modified Rankin Scale score 3–6) and mortality within 90 days. Secondary end points were any of 5 prespecified complications during hospitalization.
Results: In multivariate analysis, higher copeptin independently predicted unfavorable outcome (adjusted odds ratio 2.17 for any 10-fold copeptin increase [95% confidence interval {CI}, 1.46–3.22], p < 0.001), mortality (adjusted hazard ratio 2.40 for any 10-fold copeptin increase [95% CI, 1.60–3.60], p < 0.001), and complications (adjusted odds ratio 1.93 for any 10-fold copeptin increase [95% CI, 1.33–2.80], p = 0.001). The discriminatory accuracy, calculated with the area under the receiver operating characteristic curve, improved significantly for all end points when adding copeptin to the NIH Stroke Scale score and the multivariate models. Moreover, the combination of copeptin with a validated score encompassing both the NIH Stroke Scale and age led to a net reclassification improvement of 11.8% for functional outcome and of 37.2% for mortality.
Conclusions: In patients with ischemic stroke, copeptin is a validated blood marker that adds predictive information for functional outcome and mortality at 3 months beyond stroke severity and age. Copeptin seems to be a promising new blood marker for prediction of in-hospital complications.
GLOSSARY
- AUC=
- area under the curve;
- AVP=
- arginine vasopressin;
- CI=
- confidence interval;
- CRP=
- C-reactive protein;
- HR=
- hazard ratio;
- mRS=
- modified Rankin Scale;
- IQR=
- interquartile range;
- NIHSS=
- NIH Stroke Scale;
- NRI=
- net reclassification improvement;
- OR=
- odds ratio;
- ROC=
- receiver operating characteristic
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
Editorial, page 1270
- Received May 29, 2012.
- Accepted November 9, 2012.
- © 2013 American Academy of Neurology
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