Introduction: Grading of patients with aneurysmal subarachnoid hemorrhage (aSAH) is often confounded by seizure, hydrocephalus or sedation and the prediction of prognosis remains difficult. Recently, copeptin has been identified as a serum marker for outcomes in acute ischemic stroke and intracerebral hemorrhage (ICH). We investigated whether copeptin might serve as a marker for severity and prognosis in aSAH.
Methods: Eighteen consecutive patients with SAH had plasma copeptin levels measured with a validated chemiluminescence sandwich immunoassay. The primary endpoint was the association of admission copeptin levels with the World Federation of Neurological Surgeons (WFNS) grade score after resuscitation. Levels of copeptin were compared across clinical and radiological scores as well as between patients with ICH, intraventricular hemorrhage, hydrocephalus, vasospasm and ischemia
Results: Copeptin levels had a significant association with the severity of SAH measured by WFNS grade (P=0.006), the amount of subarachnoid blood (P=0.03) and the occurrence of ICH (P=0.02). There was also a trend between copeptin levels and functional clinical outcome at 6-months (P=0.054). No other clinical outcomes showed any statistically significant association.
Conclusions: Copeptin may indicate clinical severity of the initial bleeding and may therefore help in guiding treatment decisions in the setting of aSAH. These initial results show that copeptin might also have prognostic value for clinical outcome in SAH.
Patient Care: Copeptin might evolve as a useful serum marker for SAH. Thereby it might help in selecting high risk patients and might also be useful in the diagnosis of SAH related vasospasm.
Learning Objectives: By the end of this session the audience should know
1)about the possible usefulness of Copeptin as serum marker in SAH
2)that Copeptin is associated with the severity of SAH, the amount of subarachnoid blood and the occurence of ICH
References: 1. Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale J Neurosurg 1988;68:985-986.
2. Bederson JB, Connolly ES, Jr., Batjer HH et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association Stroke 2009;40:994-1025.
3. Le Roux PD, Elliott JP, Newell DW et al. Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases J Neurosurg 1996;85:39-49.
4. Morgenthaler NG, Muller B, Struck J et al. Copeptin, a stable peptide of the arginine vasopressin precursor, is elevated in hemorrhagic and septic shock Shock 2007;28:219-226.
5. Zweifel C, Katan M, Schuetz P et al. Copeptin is associated with mortality and outcome in patients with acute intracerebral hemorrhage BMC Neurol 2010;10:34.
6. Katan M, Fluri F, Morgenthaler NG et al. Copeptin: a novel, independent prognostic marker in patients with ischemic stroke Ann Neurol 2009;66:799-808.
7. Macdonald RL, Higashida RT, Keller E et al. Preventing vasospasm improves outcome after aneurysmal subarachnoid hemorrhage: rationale and design of CONSCIOUS-2 and CONSCIOUS-3 trials Neurocrit Care 2010;13:416-424.
8. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning Neurosurgery 1980;6:1-9.
9. Kothari RU, Brott T, Broderick JP et al. The ABCs of measuring intracerebral hemorrhage volumes Stroke 1996;27:1304-1305.
10. Lackner P, Dietmann A, Beer R et al. Cellular microparticles as a marker for cerebral vasospasm in spontaneous subarachnoid hemorrhage Stroke 2010;41:2353-2357.
11. Zhu XD, Chen JS, Zhou F et al. Detection of copeptin in peripheral blood of patients with aneurysmal subarachnoid hemorrhage Crit Care 2011;15:R288.