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| LETTER TO EDITOR |
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| Year : 2022 | Volume
: 8
| Issue : 1 | Page : 85-86 |
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The role of copeptin in the prognosis of ischemic stroke
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| Date of Submission | 16-Dec-2021 |
| Date of Decision | 07-Feb-2022 |
| Date of Acceptance | 08-Feb-2022 |
| Date of Web Publication | 28-Apr-2022 |
Correspondence Address:
Dr. Jamir Pitton Rissardo
Av. Roraima, 1000 - Camobi, Santa Maria - RS 97105-900
Brazil
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcrsm.jcrsm_91_21
How to cite this article:
Rissardo JP, Fornari Caprara AL. The role of copeptin in the prognosis of ischemic stroke. J Curr Res Sci Med 2022;8:85-6 |
Dear Sir,
We read the article entitled “Copeptin: Short-term prognostic biomarker in ischemic stroke among Indian: A prospective cohort study” in the esteemed “Journal of Current Research in Scientific Medicine” with great interest. John et al. assessed copeptin as a prognostic marker in individuals with acute ischemic stroke by evaluating the functional outcome of patients after 90 days of a cerebrovascular event. They showed that this biomarker at the time of admission significantly correlated (r = 0.702; P < 0.001) with stroke severity.[1]
Copeptin, also known as CT-proAVP, is an amino acid usually derived from arginine vasopressin. It has been used as a prognostic biomarker in several conditions including heart failure, myocardial infarction, shock, sepsis, pneumonia, lower respiratory tract infections, and traumatic brain injury. Furthermore, copeptin was assessed for functional outcome and death in patients with cerebrovascular accidents.
[Figure 1] is a schematic representation of the possible pathophysiology process involving copeptin and stroke. The receptors and their site of action were selected based on the mechanism of cerebrovascular events. It is worthy of mentioning that vasopressin is equimolar to copeptin, so both hormones may influence this pathway.[2]{Figure 1}
A recent meta-analysis about serum biomarkers in the setting of ischemic stroke was performed to predict long-term outcomes. It was observed that copeptin was significantly associated with long-term outcomes after ischemic stroke (odds ratio, 7.8; 95% confidence interval, 1.7–34.7; P = 0.01). Furthermore, copeptin was among the most studied stroke biomarkers, along with C-reactive protein, S100 β, albumin, and D-dimer. Moreover, it was the most common hormonal biomarker evaluated in ischemic stroke individuals.[3]
Oraby et al. assessed copeptin levels after 3 months of a stroke episode. They observed similar results to the study by John et al. Copeptin levels were significantly higher in patients with severe stroke and patients with unfavorable outcomes. It is noteworthy that copeptin levels were significantly lower in individuals who received thrombolytic therapy with recombinant tissue plasminogen activator (P = 0.049). This can support the hypothesis of intravenous thrombolysis role in reducing ischemic lesion volume and neurological deficits after acute ischemic stroke.[4]
An interesting query about copeptin and the studies already reported is if its levels can be influenced by the patients' comorbidity conditions, which are commonly found in individuals who suffered a cerebrovascular event. The best answer may be that copeptin is influenced if the comorbidity condition is related to the basic principles of osmotic stimulus and hemodynamic stimulus. For example, diabetes appears to not influence copeptin levels in individuals suffering an ischemic stroke, but congestive heart failure has been reported to increase the levels of this biomarker.[2],[3]
After many studies were published about the association between copeptin and ischemic stroke, new manuscripts are showing its relation with intracerebral hemorrhages. Troiani et al. demonstrated that copeptin, S100 calcium-binding protein B, and white blood cell count were the most studied biomarkers for the outcomes of intracerebral hemorrhages. Furthermore, copeptin when compared with other biomarkers has a high predictive value for prognosis and has the obvious advantage of prognostic prediction of intracerebral hemorrhage.[5]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | John KT, Faiz Karnam AH, Kandasamy R, Sarangi R, Iqbal N, Nanda SK. Copeptin: Short term prognostic biomarker in ischemic stroke among Indian – A prospective cohort study. J Curr Res Sci Med 2020;6:77-83.  |
| 2. | Martino M, Arnaldi G. Copeptin and stress. Endocrines 2021;2:384-404. |
| 3. | Soldozy S, Yağmurlu K, Norat P, Elsarrag M, Costello J, Farzad F, et al. Biomarkers Predictive of long-term outcome after ischemic stroke: A meta-analysis. World Neurosurg 2021:S1878-5. |
| 4. | Oraby MI, Soliman RH, Abd Elkareem RM, Mohammed AI. Copeptin: A potential blood biomarker for acute ischemic stroke. Egypt J Neurol Psychiatry Neurosurg 2021;57:1-8. |
| 5. | Troiani Z, Ascanio L, Rossitto CP, Ali M, Mohammadi N, Majidi S, et al. Prognostic utility of serum biomarkers in intracerebral hemorrhage: A systematic review. Neurorehabil Neural Repair 2021;35:946-59. |
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