copeptin用于急诊非创伤性头痛的风险分层：一项前瞻性多中心观察性队列研究
Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study.
作者信息
Blum Claudine Angela, Winzeler Bettina, Nigro Nicole, Schuetz Philipp, Biethahn Silke, Kahles Timo, Mueller Cornelia, Timper Katharina, Haaf Katharina, Tepperberg Janina, Amort Margareth, Huber Andreas, Bingisser Roland, Sándor Peter Stephan, Nedeltchev Krassen, Müller Beat, Katan Mira, Christ-Crain Mirjam
机构信息
Division of Endocrinology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Internal Medicine, Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland.
出版信息
J Headache Pain. 2017 Dec;18(1):21. doi: 10.1186/s10194-017-0733-2. Epub 2017 Feb 13.
BACKGROUND
In the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out. Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting.
METHODS
Patients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study. Copeptin was measured upon presentation to the emergency department. Primary endpoint was serious secondary headache defined by a neurologic cause requiring immediate treatment of the underlying disease. Secondary endpoint was the combination of mortality and hospitalization within 3 months. Two board-certified neurologist blinded to copeptin levels verified the endpoints after a structured 3-month-telephone interview.
RESULTS
Of the 391 patients included, 75 (19%) had a serious secondary headache. Copeptin was associated with serious secondary headache (OR 2.03, 95%CI 1.52-2.70, p < 0.0001). Area under the curve (AUC) for copeptin to identify the primary endpoint was 0.70 (0.63-0.76). After adjusting for age > 50, focal-neurological abnormalities, and thunderclap onset of symptoms, copeptin remained an independent predictive factor for serious secondary headache (OR 1.74, 95%CI 1.26-2.39, p = 0.001). Moreover, copeptin improved the AUC of the multivariate logistic clinical model (p-LR-test < 0.001). Even though copeptin values were higher in patients reaching the secondary endpoint, this association was not significant in multivariate logistic regression.
CONCLUSIONS
Copeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.
TRIAL REGISTRATION
Study Registration on 08/02/2010 as NCT01174901 at clinicaltrials.gov.
背景
在急诊情况下，80%的非创伤性头痛病例为良性症状，但仍需排除严重的潜在疾病。 copeptin可改善多种急性疾病的风险分层。在此，我们研究了copeptin在急诊情况下鉴别严重继发性头痛和良性头痛类型的价值。
方法
前瞻性纳入出现急性非创伤性头痛的患者进行观察性队列研究。在患者到急诊科就诊时检测copeptin。主要终点为需要对基础疾病进行立即治疗的神经系统病因所定义的严重继发性头痛。次要终点为3个月内的死亡率和住院率。两名对copeptin水平不知情的经董事会认证的神经科医生在经过结构化的3个月电话访谈后核实终点。
结果
纳入的391例患者中，75例（19%）患有严重继发性头痛。copeptin与严重继发性头痛相关（比值比2.03，95%置信区间1.52 - 2.70，p < 0.0001）。copeptin识别主要终点的曲线下面积（AUC）为0.70（0.63 - 0.76）。在调整年龄>50岁、局灶性神经功能异常和症状雷击样发作后，copeptin仍然是严重继发性头痛的独立预测因素（比值比1.74，95%置信区间1.26 - 2.39，p = 0.001）。此外，copeptin改善了多变量逻辑临床模型的AUC（p - LR检验<0.001）。尽管达到次要终点的患者copeptin值较高，但在多变量逻辑回归中这种关联并不显著。
结论
与良性头痛类型相比，copeptin与严重继发性头痛独立相关。copeptin可能是一种有前景的新型血液生物标志物，应进一步验证其在急诊科排除严重继发性头痛的作用。
试验注册
2010年2月8日在clinicaltrials.gov上注册为NCT01174901。
Zotero 插件