copeptin用于预测短暂性脑缺血发作后复发性脑血管事件：CoRisk研究结果
Copeptin for the prediction of recurrent cerebrovascular events after transient ischemic attack: results from the CoRisk study.
作者信息
De Marchis Gian Marco, Weck Anja, Audebert Heinrich, Benik Steffen, Foerch Christian, Buhl Daniela, Schuetz Philipp, Jung Simon, Seiler Marleen, Morgenthaler Nils G, Mattle Heinrich P, Mueller Beat, Christ-Crain Mirjam, Arnold Marcel, Katan Mira
机构信息
From the Departments of Neurology and Clinical Chemistry, Inselspital, University of Bern, Bern, Switzerland (G.M.D.M., A.W., D.B., S.J., H.P.M., M.A.); Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY (G.M.D.M.); Department of Neurology (G.M.D.M.) and Department of Endocrinology (M.C.-C.), University Hospital of Basel, Basel, Switzerland; Departments of Neurology (H.A., S.B.) and Endocrinology (N.G.M.), Charité, Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Goethe University, Frankfurt am Main, Germany (C.F.); Medical University Department, Kantonsspital Aarau, Aarau, Switzerland (P.S., B.M.); Thermo Fisher Scientific Clinical Diagnostics BRAHMS GmbH, Hennigsdorf-Berlin, Germany (M.S.); and Department of Neurology, University Hospital of Zurich, Zurich, Switzerland (M.K.).
出版信息
Stroke. 2014 Oct;45(10):2918-23. doi: 10.1161/STROKEAHA.114.005584. Epub 2014 Aug 28.
BACKGROUND AND PURPOSE
Copeptin has been associated with recurrent cerebrovascular events after transient ischemic attack (TIA). In an independent cohort, we evaluated copeptin for the prediction of recurrent cerebrovascular events within 3 months after TIA and assessed the incremental value of copeptin compared with the ABCD2 (age, blood, clinical features of TIA, duration of symptoms, presence of diabetes mellitus) and ABCD3-I (ABCD2, dual TIA [the presence of ≥2 TIA symptoms within 7 days], imaging [the presence of abnormal findings on neuroimaging]) scores.
METHODS
This prospective, multicenter cohort study was conducted at 3 tertiary Stroke Centers in Switzerland and Germany.
RESULTS
From March 2009 through April 2011, we included 302 patients with TIA admitted within 24 hours from symptom onset. Of 28 patients with a recurrent cerebrovascular event within 3 months (stroke or TIA), 11 patients had a stroke. Although the association of copeptin with recurrent cerebrovascular events was not significant, the association with stroke alone as end point was significant. After adjusting for the ABCD2 score, a 10-fold increase in copeptin levels was associated with an odds ratio for stroke of 3.39 (95% confidence interval, 1.28-8.96; P=0.01). After addition of copeptin to the ABCD2 score, the area under the curve of the ABCD2 score improved from 0.60 (95% confidence interval, 0.46-0.74) to 0.74 (95% confidence interval, 0.60-0.88, P=0.02). In patients with MRI (n=223), the area under the curve of the ABCD3-I score increased in similar magnitude, although not significantly. Based on copeptin, 31.2% of patients were correctly reclassified across the risk categories of the ABCD2 score (net reclassification improvement; P=0.17).
CONCLUSIONS
Copeptin improved the prognostic value of the ABCD2 score for the prediction of stroke but not TIA, and it may help clinicians in refining risk stratification for patients with TIA.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT00878813.
背景与目的
copeptin与短暂性脑缺血发作（TIA）后的复发性脑血管事件相关。在一个独立队列中，我们评估了copeptin对TIA后3个月内复发性脑血管事件的预测价值，并评估了copeptin相对于ABCD2（年龄、血压、TIA临床特征、症状持续时间、糖尿病）和ABCD3-I（ABCD2、双重TIA[7天内≥2次TIA症状]、影像学[神经影像学异常发现]）评分的增量价值。
方法
这项前瞻性、多中心队列研究在瑞士和德国的3个三级卒中中心进行。
结果
从2009年3月至2011年4月，我们纳入了症状发作后24小时内入院的302例TIA患者。在3个月内发生复发性脑血管事件（卒中或TIA）的28例患者中，11例发生了卒中。虽然copeptin与复发性脑血管事件的关联不显著，但与单独以卒中作为终点的关联显著。在调整ABCD2评分后，copeptin水平增加10倍与卒中的比值比为3.39（95%置信区间，1.28-8.96；P=0.01）。将copeptin加入ABCD2评分后，ABCD2评分的曲线下面积从0.60（95%置信区间,0.46-0.74）提高到0.74（95%置信区间，0.60-0.88，P=0.02）。在进行MRI检查的患者（n=223）中，ABCD3-I评分的曲线下面积虽有相似幅度增加，但不显著。基于copeptin，31.2%的患者在ABCD2评分的风险类别中被正确重新分类（净重新分类改善；P=0.17）。
结论
Copeptin提高了ABCD2评分对卒中而非TIA的预测预后价值，可能有助于临床医生完善TIA患者的风险分层。
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