Neurology：和肽素有助判断缺血性卒中的预后

和肽素能够独立预测功能转归和死亡率

和肽素增高相比于那些已经确定的临床变量在预测转归和并发症上的作用尚不清楚。为此，瑞典伯尔尼大学神经内科的Gian Marco De Marchis博士等人进行了一项研究。研究结果在线发表在2013年3月6日的Neurology杂志上。研究结果显示：对于缺血性卒中患者，和肽素是除了卒中严重程度和年龄之外能够增加功能转归和3个月死亡预测效力的实用血液标志物。
该研究是CoRisk研究，是一个前瞻性多中心队列研究。研究人员测定了急诊室里783位症状出现24小时内的急性缺血性卒中患者的和肽素。两个主要终点事件为不良的功能转归（改良Rankin评分3-6分）及90天内死亡。次要终点事件为住院期间出现5种特定并发症中的一种。
研究结果显示：在多变量分析中，和肽素较高独立预测不良转归(和肽素10倍以上增高的校正优势比为2.17 [95%可信区间{CI}, 1.46–3.22], p < 0.001)、死亡 (和肽素10倍以上增高的校正风险比为2.40[95% CI, 1.60–3.60], p < 0.001)和并发症(和肽素10倍以上增高的校正优势比为：1.93 [95% CI,1.33–2.80], p = 0.001)。将和肽素加入NIHSS量表和多变量模型后，区分的精确度、计算受者操作特性曲线的曲线下面积在各种终点上均显著改善。而且，联合使用和肽素与融合了NIHSS和年龄的实用量表对患者进行重新分组。重新分组后功能转归区分度净增加11.8%，死亡情况净增加37.2%。
该研究发现：对于缺血性卒中患者，和肽素是除了卒中严重程度和年龄之外能够增加功能转归和3个月死亡预测效力的实用血液标志物。和肽素有望成为预测院内并发症的新的血液标志物。

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Copeptin adds prognostic information after ischemic stroke: Results from the CoRisk study.
OBJECTIVE
To evaluate and validate the incremental value of copeptin in the prediction of outcome and complications as compared with established clinical variables.
METHODS
In this prospective, multicenter, cohort study, we measured copeptin in the emergency room within 24 hours from symptom onset in 783 patients with acute ischemic stroke. The 2 primary end points were unfavorable functional outcome (modified Rankin Scale score 3-6) and mortality within 90 days. Secondary end points were any of 5 prespecified complications during hospitalization.
RESULTS
In multivariate analysis, higher copeptin independently predicted unfavorable outcome (adjusted odds ratio 2.17 for any 10-fold copeptin increase [95% confidence interval {CI}, 1.46-3.22], p < 0.001), mortality (adjusted hazard ratio 2.40 for any 10-fold copeptin increase [95% CI, 1.60-3.60], p < 0.001), and complications (adjusted odds ratio 1.93 for any 10-fold copeptin increase [95% CI, 1.33-2.80], p = 0.001). The discriminatory accuracy, calculated with the area under the receiver operating characteristic curve, improved significantly for all end points when adding copeptin to the NIH Stroke Scale score and the multivariate models. Moreover, the combination of copeptin with a validated score encompassing both the NIH Stroke Scale and age led to a net reclassification improvement of 11.8% for functional outcome and of 37.2% for mortality.
CONCLUSIONS
In patients with ischemic stroke, copeptin is a validated blood marker that adds predictive information for functional outcome and mortality at 3 months beyond stroke severity and age. Copeptin seems to be a promising new blood marker for prediction of in-hospital complications.