Service d'Acceuil des Urgences, SAMU 86, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France.
INSERM U1070, Université de Poitiers, Poitiers, France.
Scand J Trauma Resusc Emerg Med. 2019 Aug 6;27(1):72. doi: 10.1186/s13049-019-0651-1.
Dizziness is a frequent reason for visiting emergency departments (EDs). Differentiating stroke from other causes is challenging for physicians. The role of biomarkers has been poorly assessed. We evaluated whether copeptin and S100b protein (PS100b) assessment, alone or in combination, could rule out stroke in patients visiting EDs for dizziness.
We included patients 18 years of age or older, visiting the adult ED of a French university hospital for a new episode of dizziness evolving for less than 72 h. All patients underwent standardized physical examination (HINT [Head Impulse test, Nystagmus, test of skew deviation] maneuvers), copeptin and S-100b protein (PS100) measurement and injected brain imaging. Stroke diagnosis involved diffusion-weighted magnetic resonance imaging or, if not available, neurological examination and contrast brain CT scan compatible with the diagnosis.
Of the 135 patients participating in the study, 13 (10%) had stroke. The sensitivity, specificity and positive and negative predictive values of copeptin/PS100 combination were 100% (95%CI, 77-100%), 48% (40-57%), 14% (11-27%) and 100% (94-100%), respectively. Values for copeptin alone were 77% (CI95% 0.50-0.91), 50% (CI95% 0.49-0.58), 14% (CI95% 0.08-0.24), 93% (CI95% 0.87-0.98), and for PS100 alone were 54% (CI95% 0.29-0.77), 97% (CI95% 0.92-0.99), 64% (CI95% 0.35-0.84), 95% (CI95% 0.90-0.98).
Absence of copeptin and PS100 elevation seems to ruling out the diagnosis of stroke in patients visiting the ED for a new episode of dizziness. These results need to be confirmed in a large-scale study.
头晕是急诊科（ED）就诊的常见原因。医生很难将中风与其他病因区分开来。生物标志物的作用评估不佳。我们评估了在因头晕就诊 ED 的患者中，单独或联合检测 copeptin 和 S100b 蛋白（PS100b）是否可以排除中风。
我们纳入了年龄在 18 岁或以上、因新发作的头晕就诊于法国一家大学医院成人 ED 的患者，头晕发作时间少于 72 小时。所有患者均接受了标准化的体格检查（HINT [头部脉冲试验、眼震、偏斜偏差测试] 操作）、copeptin 和 S-100b 蛋白（PS100）测量和脑部注射成像。中风诊断包括弥散加权磁共振成像，如果不可用，则进行神经学检查和与诊断相符的对比脑 CT 扫描。
在 135 名参与研究的患者中，有 13 名（10%）患有中风。 copeptin/PS100 联合检测的灵敏度、特异性和阳性及阴性预测值分别为 100%（95%CI，77-100%）、48%（40-57%）、14%（11-27%）和 100%（94-100%），而 copeptin 单独检测的结果分别为 77%（95%CI，0.50-0.91）、50%（95%CI，0.49-0.58）、14%（95%CI，0.08-0.24）和 93%（95%CI，0.87-0.98%），PS100 单独检测的结果分别为 54%（95%CI，0.29-0.77）、97%（95%CI，0.92-0.99%）、64%（95%CI，0.35-0.84%）和 95%（95%CI，0.90-0.98%）。
在因新发作的头晕就诊 ED 的患者中，如果不存在 copeptin 和 PS100 升高，则似乎可以排除中风的诊断。这些结果需要在大规模研究中得到证实。
