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Stress hormones predict cerebrovascular re-events after transient ischemic attacks.
MedLine Citation:
PMID:  21228295     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
M Katan; N Nigro; F Fluri; P Schuetz; N G Morgenthaler; F Jax; S Meckel; A Gass; R Bingisser; A Steck; L Kappos; S Engelter; B Müller; M Christ-Crain
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-12
Journal Detail:
Title:  Neurology     Volume:  -     ISSN:  1526-632X     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Departments of Endocrinology (M.K., N.N., P.S., M.C.-C.), Neurology (M.K., F.F., A.G., A.S., L.K., S.E.), Neuroradiology (F.J., S.M., A.G.), and Internal Medicine (R.B.), University Hospital Basel, Basel, Switzerland; Research Department (N.G.M.), Brahms AG, Hennigsdorf/Berlin, Germany; and Department of Internal Medicine (B.M.), Kantonsspital Aarau, Aarau, Switzerland.
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