Key result
Plasma copeptin levels were significantly higher in stroke patients compared to non-stroke patients (MD 12.75) and were associated with poorer outcomes and increased mortality.
Why the study?
Copeptin has emerged as a potential stress-response biomarker, but its diagnostic and prognostic value for risk stratification after acute ischemic stroke and transient ischemic attack required systematic assessment.
Do plasma copeptin concentrations predict diagnosis and prognosis in patients with acute ischemic stroke and transient ischemic attack?
Systematic Review (n=5,057)
Do plasma copeptin concentrations predict diagnosis and prognosis in patients with acute ischemic stroke and transient ischemic attack?
Mean Difference: 12.75 (95% CI 5–20.49)
Absolute Event Rate: 19.8% vs 9.7%
p-value: p=<0.001
Elevated plasma copeptin levels are significantly associated with the diagnosis of ischemic stroke, poor outcomes, and mortality, suggesting its utility as a prognostic biomarker.
Copeptin may aid ischemic stroke diagnosis and prognosis; leaves open routine use pending prospective validation.
BACKGROUND: Stroke is the second main cause of mortality and the third leading cause of mortality and permanent disability combined. Many potential biomarkers have been described to contribute to the diagnosis, prognosis of outcomes, and risk stratification after stroke. Copeptin is an inactive peptide that is produced in an equimolar ratio to arginine vasopressin (AVP) in response to the activation of the endogenous stress system. METHODS: The present study isa systematic review and meta-analysis to assess plasma copeptin concentrations, diagnostic and prognostic values for risk stratification after acute ischemic stroke and transient ischemic attack. RESULTS: Mean copeptin level in stroke vs. non-stroke groups varied and amounted to 19.8 ± 17.4 vs. 9.7 ± 6.6 pmol/L, respectively (mean differences [MD]: 12.75; 95% confidence interval [CI]: 5.00 to 20.49; p < 0.001), in good vs. poor outcome 12.0 ± 3.6 vs. 29.4 ± 14.5 (MD: -8.13; 95% CI: -8.37 to -7.88; p < 0.001) and in survive vs. non-survive stroke patients: 13.4 ± 3.2 vs. 33.0 ± 12.3, respectively (MD: -13.43; 95% CI: -17.82 to -9.05; p < 0.001). CONCLUSIONS: The above systematic review and meta-analysis suggests that monitoring the copeptin levels may help predict the long-term prognosis of ischemic stroke efficiently. Determining the copeptin level may help individualize the management of ischemic stroke patients, keep stroke risk lower, reduce post-stroke complications, including patient death, and minimize healthcare costs.
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Blek et al. (2022) conducted a systematic review in Acute ischemic stroke and transient ischemic attack (n=5,057). Plasma copeptin concentration vs. Non-stroke patients was evaluated on Mean copeptin level in stroke vs. non-stroke groups (MD 12.75, 95% CI 5.00 to 20.49, p=<0.001). Plasma copeptin levels were significantly higher in stroke patients compared to non-stroke patients (MD 12.75) and were associated with poorer outcomes and increased mortality.
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