Copeptin: Limited Usefulness in Early Stroke Differentiation?

Abstract EN

Background.

Stroke can be a challenging diagnosis in an emergency-setting.

We sought to determine whether copeptin may be a useful biomarker to differentiate between ischemic stroke (IS), transient ischemic attack (TIA), and stroke-mimics.

Methods.

In patients with suspected stroke arriving within 4.5 hours of symptom-onset, copeptin-levels were measured in initial blood-samples.

The final diagnosis was adjudicated by vascular neurologists blinded to copeptin-values.

Results.

Of all 36 patients with available copeptin-values (median age 71 years, IQR: 54–76; 44% female), 20 patients (56%) were diagnosed with IS, no patient was diagnosed with hemorrhagic stroke, nine patients (25%) were diagnosed with TIA, and seven patients (19%) were stroke-mimics.

Copeptin-levels (in pmol/L) tended to be higher in patients with IS [19.1 (11.2–48.5)] compared to TIA [9.4 (5.4–13.8)].

In stroke-mimics the range of values was extremely broad [33.3 (7.57–255.7)].

The diagnostic accuracy of copeptin for IS was 63% with a sensitivity of 80% and a positive predictive value of 64%.

Conclusion.

In this cohort of patients copeptin-levels within 4.5 hours of symptom onset were higher in patients with IS compared to TIA but the broad range of values in stroke-mimics limits diagnostic accuracy.

This trial is registered with UTN: U1111-1119-7602.