Copeptin as a biomarker for prediction of prognosis of acute ischemic stroke and transient ischemic attack: a meta-analysis

This meta-analysis aimed to investigate the predictive effect of copeptin as a biomarker for the prognosis of acute ischemic stroke and transient ischemic attack. Electronic databases including PubMed, Medline, EMBASE, Web of Science and Cochrane Central were searched for studies assessing the association of copeptin level on admission with prognosis of acute ischemic stroke and transient ischemic attack. The Newcastle-Ottawa Quality assessment scale for cohort study was used to evaluate quality. A total of 1976 acute ischemic stroke patients from 6 studies were included, and 59% of patients were male. Patients with poor outcomes and nonsurvivors had a higher copeptin level at admission (P<0.0001). Copeptin combined with an admission National Institutes of Health Stroke Scale score significantly improved the discriminatory accuracy of functional outcome and mortality compared with the National Institutes of Health Stroke Scale alone. Elevation in plasma copeptin level carried a higher risk of all-cause mortality (odds ratio = 4.16; 95% CI: 2.77-6.25) and poor functional outcome (odds ratio = 2.56; 95% CI: 1.97-3.32) after acute ischemic stroke. In addition, copeptin improved the prognostic value of the ABCD2 (age, blood pressure, clinical features of transient ischemic attack, duration of symptoms and presence of diabetes mellitus) score for a recurrent cerebrovascular event in transient ischemic attack. Copeptin seems to be a promising independent biomarker for predicting the functional outcome and all-cause mortality within 3 months or 1 year after acute ischemic stroke, and it could also be a powerful tool for early risk stratification for patients with transient ischemic attack.