The Effect Of Plasma Copeptin On Long-term Outcomes In Early Ischemic Stroke

Background：Stroke is the first leading cause of mortality in the China and one of theleading causes of severe morbidity.15to30%of stroke survivors will be permanentlydisabled. Abnormalities in endocrine function have been reported in acute ischemic strokewith activation of the hypothalamo-pituitary-adrenal axis being one of the first measurablephysiological responses to cerebral ischemia. Due to the positive association of copeptin withthe severity of illness and outcome, copeptin has been proposed as a prognostic marker inacute illness. Some studies have found that increased copeptin levels are associated withoutcome and (or) severity in patients with ischemic stroke, intracerebral hemorrhage,traumatic brain injury, transient ischemic attacks. This study aimed at prospectivelyevaluating the prognostic value of copeptin levels in a cohort of Chinese patients with anacute ischemic stroke.Objective: The identification of patients at highest risk for adverse outcome who arepresenting with acute ischemic stroke to the emergency department remains a challenge. Thisstudy firstly investigates the long-term prognostic value of the stress marker copeptin inChinese patients with acute ischemic stroke.Methods: In a prospective study, copeptin levels were measured using a sandwichimmunoassay on admission in plasma of245consecutive patients with an acute ischemicstroke. The prognostic value of copeptin to predict the functional outcome and mortalitywithin one year was compared with the National Institutes of Health Stroke Scale score andwith other known outcome predictors.Results: Patients with an unfavorable outcomes and nonsurvivors had significantlyincreased copeptin levels on admission (P<0.05and P<0.05). Multivariate Cox regressionanalysis adjusted for common risk factors showed that copeptin was an independent predictor of functional outcome (hazard ratio=3.88;95%CI:1.94–7.77) and nonsurvivors (hazard ratio=5.99;95%CI:2.55-14.07). The area under the receiver operating characteristic curve ofcopeptin was0.75(95%CI,0.70–0.82) for functional outcome and0.867(95%CI,0.802–0.933) for mortality.Conclusions: Copeptin levels are a novel and complementary biomarker to predictfunctional outcome and mortality1year after acute ischemic stroke.