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Abstract
Background: TIA is a strong predictor of subsequent stroke. The hypothalamic stress hormone copeptin is an accurate prognostic marker in acute ischemic stroke. This study assessed prognostic reliability of 2 distinct stress hormones, copeptin and cortisol, for the risk stratification of re-events in patients with TIA.
Methods: We conducted a prospective study in patients admitted to the emergency department with a TIA. Clinical risk scoring using the ABCD2 score was determined and both hormones were measured in plasma on admission. The primary endpoint was a cerebrovascular re-event within 90 days.
Results: We included 107 consecutive patients with TIA. Re-events occurred in 10 patients (9%). Copeptin levels were higher in patients with a re-event compared with patients without re-event (p = 0.02), in contrast to cortisol (p = 0.53). Copeptin revealed a higher area under the receiver operating characteristics curve (AUC) to predict re-events compared to the ABCD2 score (AUC of 0.73 vs 0.43; p < 0.01) and improved its prognostic accuracy (AUC of combined model of 0.77; p = 0.002).
Conclusion: Measurement of plasma copeptin but not cortisol levels in patients with TIA provides additional prognostic information beyond the ABCD2 clinical risk score alone. If confirmed in future studies, routine copeptin measurement may be an additional tool for risk stratification and targeted resource allocation after TIA.
Footnotes
Study funding: Supported by in-house grants of the Departments of Endocrinology, Diabetology and Clinical Nutrition and Neurology of the University Hospital of Basel, Switzerland; a grant for young research scientists of the University of Basel, Switzerland, to M.K.; and by research grants of the Swiss National Foundation, PP00P3-12346, to M.C.-C.
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- AUC
- area under the receiver operating characteristics curve
- CI
- confidence interval
- DWI
- diffusion-weighted imaging
- HPA axis
- hypothalamic-pituitary-adrenal axis
- IQR
- interquartile range
- ROC
- receiver operating characteristic.
- Received March 31, 2010.
- Accepted October 4, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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