The determination of copeptin levels helps management decisions among transient ischaemic attack patients

• Published in: Acta neurologica Scandinavica Vol. 134; no. 2; pp. 140 - 147
• Main Authors: Purroy, F., Suárez-Luis, I., Cambray, S., Farré, J., Benabdelhak, I., Mauri-Capdevila, G., Sanahuja, J., Quílez, A., Begué, R., Gil, M. I., Molina-Seguin, J., Torreguitart, N.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.08.2016; John Wiley & Sons, Inc
• Subjects: Aged; Aged, 80 and over; biomarker; Biomarkers; Biomarkers - blood; C-Reactive Protein - metabolism; copeptin; Disease Management; Female; Glycopeptides - blood; Humans; Interleukin-6 - blood; Ischemic Attack, Transient - blood; Ischemic Attack, Transient - diagnostic imaging; Male; Management decisions; Middle Aged; Natriuretic Peptide, Brain - blood; prognosis; S100 Calcium Binding Protein beta Subunit - blood; Tomography, X-Ray Computed; transient ischaemic attack; Tumor Necrosis Factor-alpha - blood; copeptin; transient ischaemic attack; biomarker; prognosis
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1111/ane.12523

Background Most approaches to transient ischaemic attack (TIA) triage use clinical scores and vascular imaging; however, some biomarkers have been suggested to improve the prognosis of TIA patients. Methods Serum levels of copeptin, adiponectin, neopterin, neuron‐specific enolase, high‐sensitivity C‐reactive protein, IL‐6, N‐terminal pro‐B‐type natriuretic peptide, S100β, tumour necrosis factor‐alpha and IL‐1α as well as clinical characteristics were assessed on consecutive TIA patients during the first 24 h of the onset of symptoms. Results Among 237 consecutive TIA patients, 12 patients (5%) had a stroke within 7 days and 15 (6%) within 90 days. Among all candidate biomarkers analysed, only copeptin was significantly increased in patients with stroke recurrence (SR) within 7 days (P = 0.026) but not within 90 days. A cut‐off point of 13.8 pmol/l was established with a great predictive negative value (97.4%). Large artery atherosclerosis (LAA) [hazard ratio (HR) 12.7, 95% CI 3.2–50.1, P < 0.001] and copeptin levels ≥13.8 pmol/l (HR 3.9, 95% CI 1.01–14.4, P = 0.039) were independent predictors of SR at the 7‐day follow‐up. LAA was the only predictor of 90‐day SR (HR 7.4, 95% CI 2.5–21.6, P < 0.001). ABCD3I was associated with 7‐ and 90‐day SRs (P = 0.025 and P = 0.034, respectively). The association between copeptin levels and LAA had a diagnostic accuracy of 90.3%. Conclusions Serum copeptin could be an important prognostic biomarker to guide management decisions among TIA patients. Therefore, TIA patients with copeptin levels below 13.8 pmol/l and without LAA have an insignificant risk of 7‐day SR and could be managed on an outpatient basis.