Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

The Journal of Headache and Pain

Research Article

Andreas Huber¹  Margareth Amort²  Mira Katan³  Silke Biethahn⁴  Janina Tepperberg⁴  Timo Kahles⁴  Krassen Nedeltchev⁴  Katharina Haaf⁴  Bettina Winzeler⁵  Cornelia Mueller⁵  Nicole Nigro⁵  Mirjam Christ-Crain⁵  Claudine Angela Blum⁶  Katharina Timper⁷  Roland Bingisser⁸  Beat Müller⁹  Philipp Schuetz⁹  Peter Stephan Sándor^1,10 

[1] Center of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland;Clinic of Neurology, University Hospital Basel, Basel, Switzerland;Clinic of Neurology, University Hospital Zürich, Zürich, Switzerland;Department of Neurology, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland;Division of Endocrinology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland;Division of Endocrinology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland;Internal Medicine, Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland;Division of Endocrinology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland;Max-Planck-Institute for Metabolism Research, Cologne, Germany;Emergency Department, University Hospital Basel, Basel, Switzerland;Internal Medicine, Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland;Neurology, RehaClinic AG, Bad Zurzach, Switzerland;

关键词: Headache;    Head pain;    Emergency;    Biomarker;    Copeptin;    Vasopressin;   

DOI  :  10.1186/s10194-017-0733-2

 received in 2016-11-25, accepted in 2017-02-07,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out.Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting.MethodsPatients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study. Copeptin was measured upon presentation to the emergency department. Primary endpoint was serious secondary headache defined by a neurologic cause requiring immediate treatment of the underlying disease. Secondary endpoint was the combination of mortality and hospitalization within 3 months. Two board-certified neurologist blinded to copeptin levels verified the endpoints after a structured 3-month-telephone interview.ResultsOf the 391 patients included, 75 (19%) had a serious secondary headache. Copeptin was associated with serious secondary headache (OR 2.03, 95%CI 1.52–2.70, p < 0.0001). Area under the curve (AUC) for copeptin to identify the primary endpoint was 0.70 (0.63–0.76). After adjusting for age > 50, focal-neurological abnormalities, and thunderclap onset of symptoms, copeptin remained an independent predictive factor for serious secondary headache (OR 1.74, 95%CI 1.26–2.39, p = 0.001). Moreover, copeptin improved the AUC of the multivariate logistic clinical model (p-LR-test < 0.001).Even though copeptin values were higher in patients reaching the secondary endpoint, this association was not significant in multivariate logistic regression.ConclusionsCopeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.Trial registrationStudy Registration on 08/02/2010 as NCT01174901 at clinicaltrials.gov.

【 授权许可】

CC BY   
© The Author(s). 2017