Copeptin as a biomarker for severity in acute headache: The CoHead - Study

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 130-162-Neuroendocrinology
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-143
Claudine Angela Blum*1, Philipp Schuetz1, Mira Katan2, Silke Biethahn1, Bettina Winzeler3, Nicole Nigro3, Katharina Timper3, Katharina Haaf1, Janina Tepperberg1, Andreas Huber1, Beat Mueller1 and Mirjam Christ-Crain3
1Kantonsspital Aarau, Aarau, Switzerland, 2University Hospital Zurich, Zuerich, Switzerland, 3University Hospital Basel, Basel, Switzerland
Background: In the emergency setting (ED), non-traumatic headache (NTH) is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out.

Copeptin, a surrogate for antidiuretic hormone (ADH), is a subtle marker for the individual stress level. We evaluated the prognostic value of copeptin to discriminate benign NTH from serious secondary NTH, which require prompt hospitalisation and intervention.

Methods: Patients presenting with NTH to the ED of 2 tertiary care hospitals were consecutively screened and prospectively enrolled into an observational cohort study. Baseline clinical, laboratory and radiological data were assessed and blood samples collected upon admission. Copeptin was measured by batch analysis. The final diagnosis was verified by a board-certified neurologist blinded to copeptin, based on all medical charts and the results of a structured 3-month-telephone interview. Primary endpoint was serious secondary NTH as opposed to benign, self-limiting NTH. We calculated logistic regression analysis and area under the receiver operating curve (AUC) to assess discrimination ability.

Results: Of 250 patients enrolled, 137 patients were classified as having a benign primary headache, 5 as trigeminal neuralgia, and 109 as secondary NTH. A total of 54 patients (49.5%) fullfilled criteria for the primary endpoint, serious secondary NTH. Copeptin levels were significantly associated with serious secondary NTH with an odds ratio (per 10% copeptin increase) of 1.19 (95%CI 1.06-1.33, p=0.002). The AUC for copeptin to predict serious NTH was 0.64 (95%CI 0.56-0.73). At the 5 pmol/L cut off, sensitivity was 59%, specificity 65%, the negative predictive value (NPV) was 85% and positive predictive value (PPV) was 32%, while at the 25 pmol/L cut-off, sensitivity was 92%, specificity 19%, NPV was 90% and PPV 24%.

Conclusion: Initial copeptin levels differentiate serious secondary NTH from benign headache and thereby have the potential to improve the clinical assessment and risk stratification of these patients.

Disclosure: PS: Collaborator, BRAHMS and Thermo Fisher. BM: Consultant, BRAHMS/Thermofisher. MC: Collaborator, BRAHMS/Thermofisher . Nothing to Disclose: CAB, MK, SB, BW, NN, KT, KH, JT, AH

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: W&W-Fonds of the Kantonsspital Aarau 2011-2013; young investigator grant of the University Basel 2010; Grant of the Bangerter-Rhyner-Trust 2011 and 2012.