Department of Neurosurgery, Bern University Hospital, Bern, Switzerland.
PLoS One. 2013;8(1):e53191. doi: 10.1371/journal.pone.0053191. Epub 2013 Jan 11.
Grading of patients with aneurysmal subarachnoid hemorrhage (aSAH) is often confounded by seizure, hydrocephalus or sedation and the prediction of prognosis remains difficult. Recently, copeptin has been identified as a serum marker for outcomes in acute ischemic stroke and intracerebral hemorrhage (ICH). We investigated whether copeptin might serve as a marker for severity and prognosis in aSAH.
Eighteen consecutive patients with aSAH had plasma copeptin levels measured with a validated chemiluminescence sandwich immunoassay. The primary endpoint was the association of copeptin levels at admission with the World Federation of Neurological Surgeons (WFNS) grade score after resuscitation. Levels of copeptin were compared across clinical and radiological scores as well as between patients with ICH, intraventricular hemorrhage, hydrocephalus, vasospasm and ischemia.
Copeptin levels were significantly associated with the severity of aSAH measured by WFNS grade (P = 0.006), the amount of subarachnoid blood (P = 0.03) and the occurrence of ICH (P = 0.02). There was also a trend between copeptin levels and functional clinical outcome at 6-months (P = 0.054). No other clinical outcomes showed any statistically significant association.
Copeptin may indicate clinical severity of the initial bleeding and may therefore help in guiding treatment decisions in the setting of aSAH. These initial results show that copeptin might also have prognostic value for clinical outcome in aSAH.
对伴有蛛网膜下腔出血（aSAH）的患者进行分级常常受到癫痫、脑积水或镇静的影响，预后预测仍然很困难。最近，copeptin 被确定为急性缺血性中风和脑出血（ICH）患者预后的血清标志物。我们研究了 copeptin 是否可以作为 aSAH 严重程度和预后的标志物。
连续 18 例 aSAH 患者采用经验证的化学发光夹心免疫测定法测量血浆 copeptin 水平。主要终点是入院时的 copeptin 水平与复苏后世界神经外科学联合会（WFNS）分级评分之间的关联。copeptin 水平与临床和影像学评分以及伴有 ICH、脑室内出血、脑积水、血管痉挛和缺血的患者之间进行了比较。
copeptin 水平与 WFNS 分级（P=0.006）、蛛网膜下腔血液量（P=0.03）和 ICH 发生率（P=0.02）显著相关。copeptin 水平与 6 个月时的功能临床结局之间也存在趋势（P=0.054）。其他临床结局均无统计学显著相关性。
copeptin 可能表明初始出血的临床严重程度，因此有助于指导 aSAH 治疗决策。这些初步结果表明，copeptin 对 aSAH 的临床结局也可能具有预后价值。
