SERUM COPEPTIN LEVEL AS A BIOMARKER FOR DETECTING TRANSIENT ISCHEMIC ATTACK IN THE EMERGENCY ROOM: A PROSPECTIVE CASE-CONTROL STUDY

Year 2021, Volume: 28 Issue: 3, 465 - 471, 13.09.2021

Hamit Hakan Armagan , Kıvanç Karaman , Derya Yalçın Yılmaz , Vedat Ali Yürekli , Özgür Önal , Abdurrahman Şimşek , Fevziye Burcu Şirin , Gökben Beceren , Önder Tomruk

https://doi.org/10.17343/sdutfd.970311

Abstract

Objective
We aimed to investigate the diagnostic accuracy of
copeptin to detect transient ischemic attack (TIA) by
comparing the plasma copeptin levels of patients diagnosed
with TIA who were admitted to the Emergency
Department (ED) with those of healthy controls.
Materials and Methods
We conducted a prospective case-control study
among patients admitted to the ED with a neurological
symptom. The patients diagnosed with TIA by the
neurologist were included. The results of electrocardiography,
magnetic resonance imaging, and carotid
doppler ultrasonography investigations of 38 patients;
the ED outcomes (hospitalization, discharge), the risk
group distribution (according to ABCD2 scores), and
the variables regarding one-year re-event incidence
were compared. Additionally, the serum copeptin levels
of the patients were compared to those of healthy
controls.
Results
The mean copeptin level was 435.80 ± 316.45 pg/ml
in the patient group, whereas it was 770.20 ± 912.53
pg/ml in the control group. The mean copeptin level of
patients with TIA was significantly lower (p = 0.018). In
the diagnosis of TIA, copeptin had 60.53% sensitivity
and 68.42% specificity at a cut-off value of 386.28 pg/
ml, in all the participants. In addition, in participants
above 60 years old, copeptin had 75.86% sensitivity
and 72.41% specificity at a cut-off value of 460.37 pg/
ml.
Conclusion
To the best of our knowledge, this is the first study
demonstrating the high efficacy of a serum biomarker
in the diagnosis of TIA. Emergency physicians should
search for alternative diagnoses in patients with a low
degree of clinical suspicion and a lower copeptin value.

Keywords

Arginine-vasopressin, Copeptin, Emergency, Neurology, Transient Ischemic Attack

ACİL SERVİSTE GEÇİCİ İSKEMİK ATAK TESPİTİNDE BİYOBELİRTEÇ OLARAK SERUM KOPEPTİN DÜZEYİ: PROSPEKTİF BİR VAKA KONTROL ÇALIŞMASI

Abstract

Amaç
Acil Servise (AS) başvuran TİA (Geçici iskemik atak)
tanısı almış hastaların plazma kopeptin düzeylerini
sağlıklı kontrollerle karşılaştırarak TİA saptamak
için kopeptin’in tanısal doğruluğunu araştırmayı
amaçladık.
Gereç ve Yöntem
Acil servise nörolojik bir semptomla başvuran hastalar
arasında ileriye dönük bir vaka kontrol çalışması
yaptık. Nörolog tarafından TİA tanısı konan hastalar
dahil edildi. 38 hastanın elektrokardiyografi, manyetik
rezonans görüntüleme ve karotis doppler ultrasonografi
tetkik sonuçları; Acil servis sonuçları (hastaneye
yatış, taburculuk), risk grubu dağılımı (ABCD2 puanlarına
göre) ve bir yıllık tekrar olay insidansına ilişkin
değişkenler karşılaştırıldı. Ayrıca hastaların serum kopeptin
düzeyleri sağlıklı kontrollerle karşılaştırıldı.
Bulgular
Ortalama kopeptin düzeyi hasta grubunda 435.80 ±
316.45 pg/ml iken kontrol grubunda 770.20 ± 912.53
pg/ml idi. TİA'lı hastaların ortalama kopeptin düzeyi
anlamlı olarak daha düşüktü (p = 0.018). TİA tanısında
tüm katılımcılarda kopeptin 386.28 pg/ml cut-off
değerinde %60.53 duyarlılık ve %68.42 özgüllüğe
sahipti. Ayrıca 60 yaş üstü katılımcılarda kopeptin
460.37 pg/ml cut-off değerinde %75.86 duyarlılık ve
%72.41 özgüllüğe sahipti.
Sonuç
Bildiğimiz kadarıyla bu, bir serum biyobelirteçlerinin
TİA tanısında yüksek etkinliğini gösteren ilk çalışmadır.
Klinik şüphesi düşük ve kopeptin değeri düşük
olan hastalarda acil hekimleri alternatif tanıları araştırmalıdır.

Keywords

Arginin-vazopressin, Kopeptin, Acil, Nöroloji, Geçici İskemik Atak

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