The Prognostic Value Of Copeptin In Patients With Acute Cerebrovascular Disease

Objectives:To measure plasma copeptin level of patients with acute cerebral infarction and acute intracerebral hemorrhage respectively, and to evaluate the seriousity and prognosis, to investigate the evaluation value of plasma copeptin level on prognosis of patients with acute cerebrovascular disease.Methods:Plasma copeptin level were measured by ELISA in sixty patients with acute cerebral infarction and sixty patients with acute intracerebral hemorrhage respectively. In acute cerebral infarction group, the National Institutes of Health Stroke Scale (NIHSS) score were assessed. Infarct volume were measured using magnetic resonance imaging (MRI) inspection. In acute intracerebral hemorrhage group, the hematoma volume, the Glasgow Coma Scale (GCS) and the ICH Score according to Hemphill were assessed. The body temperature, blood pressure, glucose level, white blood cell count, blood natrium level and high-sensitive c-reactive protein (hsCRP) levels were measured in both groups. Functional outcomes after90days were accessed with the modified Rankin Scale (mRS). Analyze the relationships between plasma copeptin level and prognosis of patients with acute cerebral infarction and acute intracerebral hemorrhage respectively, and then comparing the predictive value of copeptin with other prognostic indicators.Results:In acute cerebral infarction group:Plasma copeptin levels were higher significantly than those of the heathy (3.73±0.49ng/ml vs2.85±0.24ng/ml, P<0.01). Plasma copeptin levels were lower in the good prognosis subgroup compared to the poor prognosis subgroup (3.47±0.53ng/ml vs3.84±0.44ng/ml, P<0.05). Univariate Logistic regression analysis showed that plasma copeptin level, age and NIHSS score were prognostic factors of patients with acute cerebral infarction (P<0.05) Multivariate Logistic regression analysis showed that plasma copeptin level and NIHSS score were independent prognostic factors of patients with acute cerebral infarction (P<0.01). Receiver operating characteristic(ROC) analysis demonstrated that the predictive value of plasma copeptin leval was no significant diffrence to that of age,hsCRP level, infarct volume and NIHSS score.In acute intracerebral hemorrhage group:Copeptin correlated positively with hematoma volume (r=0.57, P<0.01) and Hemphill scores (r=0.63, P<0.01), and negatively with the Glasgow Coma Scale (GCS)(r=-0.69, P<0.01) on admission. Copeptin levels were higher in patients who died within30days than in30-day survivors (4.35±0.49ng/ml vs3.47±0.42ng/ml, P<0.01). Copeptin levels were also higher in the patients with an unfavorable functional outcome at90days compared to the patients with a favorable outcome (3.89±0.54ng/ml vs3.28±0.35ng/ml, P<0.01). Univariate Logistic regression analysis showed that plasma copeptin level, hematoma volume, Hemphill scores, white blood cell count and glucose level were prognostic factors of functional outcomes after90days in patients with acute intracerebral hemorrhage, and plasma copeptin level, hematoma volume, Hemphill scores, GCS scores, white blood cell count were prognostic factors of mortality in30days. Multivariate Logistic regression analysis showed that plasma copeptin level, Hemphill scores and GCS scores were independent prognostic factors of of functional outcomes after90days in patients with acute intracerebral hemorrhage, and its predictive value was consistent with the other known powerful prognostic factors such as GCS scores, hematoma volume and Hemphill scores.Interpretation:Plasma copeptin level may reflect the severity of acute cerebral infarction and acute intracerebral hemorrhage. It is a new and independent prognostic marker in patients with acute cerebrovascular disease.