Prognostic role of copeptin after stroke: A systematic review and meta-analysis of observational studies.

Kyu-Sun Choi,Hyoung-Joon Chun,Young-Soo Kim,Hyeong-Joong Yi,Choong-Hyun Kim,Jin-Hwan Cheong,Suck-Jun Oh,Jae Min Kim,Il Min Ahn,Hyeong Sik Ahn,Koang-Hum Bak,Je-Il Ryu,Taeho Lim,Yong Ko,Wonhee Kim,Hyun Jung Kim,Seon-Heui Lee

doi:10.1038/srep11665

Abstract

Copeptin, the C-terminal part of provasopressin, has emerged as a novel prognostic marker after hemorrhagic or ischemic stroke. The aim of this study was to quantitatively assess the prognostic significance of plasma copeptin level on functional outcome and mortality in patients with acute stroke using a meta-analysis of the available evidence. Thirteen relevant studies from 2,746 patients were finally included in our study. An elevated plasma copeptin level was associated with an increased risk of unfavorable outcome and mortality after stroke (OR 1.77; 95% CI, 1.44–2.19 and OR 3.90; 95% CI 3.07–4.95, respectively). The result of the pooled measure on standardized mean difference (SMD) was that plasma copeptin levels were found to be significantly higher in patients who died compared to survivors (SMD 1.70; 95% CI, 1.36–2.03). A stratified analysis by study region showed significant differences in SMD of copeptin, and the heterogeneity among studies was significantly decreased. However, the positive association of copeptin with poor prognosis after stroke was consistent in each stratified analysis. The present meta-analysis suggests that early measurement of plasma copeptin could provide better prognostic information about functional outcome and mortality in patients with acute stroke.

Highlights

Copeptin, the C-terminal part of provasopressin, is a glycopeptide of 39 amino acids that is stable at room temperature and can be measured using automated assays, with results available within 20–60 min[4,5]
A significant association of copeptin with poor outcome after stroke was observed in studies which adjusted for important prognostic factors such as age, sex, and stroke severity
These results suggest the possibility that a higher copeptin level is an independent prognostic factor for mortality and unfavorable outcome after stroke irrespective of stroke subtype

Summary

Introduction

The C-terminal part of provasopressin, is a glycopeptide of 39 amino acids that is stable at room temperature and can be measured using automated assays, with results available within 20–60 min[4,5]. Copeptin might have a role as a sensitive surrogate marker for AVP release indicating the individual stress response, because arginine-vasopressin (AVP) is a potent synergistic factor of the hypothalamo-pituitary-adrenal axis. Copeptin is significantly elevated in patients with stroke, acute myocardial infarction, heart failure, shock, and traumatic brain injury and has been proposed to be a prognostic marker for poor clinical outcome and death in these patients[5,6,7,8,9,10]. We performed a systematic review and meta-analysis of the available evidence in order to quantitatively assess the prognostic value of copeptin for functional outcome and mortality in acute stroke patients

Objectives

Methods

Conclusion