Jeon Jin Pyeong, Kim Seonghyeon, Kim Tae Yeon, Han Sung Woo, Lim Seung Hyuk, Youn Dong Hyuk, Kim Bong Jun, Hong Eun Pyo, Park Chan Hum, Kim Jong-Tae, Ahn Jun Hyong, Rhim Jong Kook, Park Jeong Jin, Kim Heung Cheol, Kang Suk Hyung
Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, South Korea.
Department of Orthopaedic Surgery, Hallym University College of Medicine, Chuncheon, South Korea.
Front Neurol. 2022 Apr 25;12:749110. doi: 10.3389/fneur.2021.749110. eCollection 2021.
Copeptin has been reported as a predictive biomarker for the prognosis after traumatic brain injury (TBI). However, most of them were in patients with severe TBI and limited value in predicting outcomes in patients with moderate TBI defined as Glasgow Coma Scale (GCS) score from 9 to 12. We aimed to investigate the predictive value of copeptin in assessing the neurologic outcome following moderate TBI.
Patients were prospectively enrolled between May 2017 and November 2020. We consecutively measured plasma copeptin within 24 h after trauma, days 3, 5, and 7 using ELISA. The primary outcome was to correlate plasma copeptin levels with poor neurologic outcome at 6 months after moderate TBI. The secondary outcome was to compare the prognostic accuracy of copeptin and C-reactive protein (CRP) in assessing the outcome of patient.
A total of 70 patients were included for the final analysis. The results showed that 29 patients (41.4%) experienced a poor neurologic outcome at 6 months. Multivariable logistic regression analysis revealed that increased copeptin (odds ration [OR] = 1.020, 95% : 1.005-1.036), GCS score of 9 or 10 ( = 4.507, 95% : 1.266-16.047), and significant abnormal findings on CT ( = 4.770; 95% : 1.133-20.076) were independent risk factors for poor outcomes. Consecutive plasma copeptin levels were significantly different according to outcomes ( < 0.001). Copeptin on day 7 exhibited better prognostic performance than CRP with an area under receiver operating characteristic curve (AUROC) difference of 0.179 (95% : 0.032-0.325) in predicting 6-month poor outcomes.
Plasma copeptin level can be a useful marker in predicting 6-month outcomes in patients with moderate TBI.
copeptin已被报道为创伤性脑损伤（TBI）后预后的预测生物标志物。然而，大多数研究针对的是重度TBI患者，对于格拉斯哥昏迷量表（GCS）评分为9至12分的中度TBI患者的预后预测价值有限。我们旨在研究copeptin在评估中度TBI后神经功能结局方面的预测价值。
前瞻性纳入2017年5月至2020年11月期间的患者。我们在创伤后24小时内、第3天、第5天和第7天使用酶联免疫吸附测定法（ELISA）连续测量血浆copeptin。主要结局是将中度TBI后6个月时血浆copeptin水平与不良神经功能结局相关联。次要结局是比较copeptin和C反应蛋白（CRP）在评估患者结局方面的预后准确性。
共纳入70例患者进行最终分析。结果显示，29例患者（41.4%）在6个月时出现不良神经功能结局。多变量逻辑回归分析显示，copeptin升高（比值比[OR]=1.020，95%可信区间：1.005-1.036）、GCS评分为9或10分（OR=4.507，95%可信区间：1.266-16.047）以及CT上有明显异常发现（OR=4.770；95%可信区间：1.133-20.076）是不良结局的独立危险因素。根据结局，连续血浆copeptin水平有显著差异（P<0.001）。在预测6个月不良结局方面，第7天的copeptin比CRP具有更好的预后性能，受试者工作特征曲线下面积（AUROC）差异为0.179（95%可信区间：0.032-0.325）。
血浆copeptin水平可作为预测中度TBI患者6个月结局的有用标志物。
