Hamit Hakan ARMAGAN, Kıvanç KARAMAN, Derya YALÇIN YILMAZ, Vedat Ali YÜREKLİ, Özgür ÖNAL, Abdurrahman ŞİMŞEK, Fevziye Burcu ŞİRİN, Gökben BECEREN, Önder TOMRUK

ACİL SERVİSTE GEÇİCİ İSKEMİK ATAK TESPİTİNDE BİYOBELİRTEÇ OLARAK SERUM KOPEPTİN DÜZEYİ: PROSPEKTİF BİR VAKA KONTROL ÇALIŞMASI

Amaç Acil Servise (AS) başvuran TİA (Geçici iskemik atak) tanısı almış hastaların plazma kopeptin düzeylerini sağlıklı kontrollerle karşılaştırarak TİA saptamak için kopeptin’in tanısal doğruluğunu araştırmayı amaçladık. Gereç ve Yöntem Acil servise nörolojik bir semptomla başvuran hastalar arasında ileriye dönük bir vaka kontrol çalışması yaptık. Nörolog tarafından TİA tanısı konan hastalar dahil edildi. 38 hastanın elektrokardiyografi, manyetik rezonans görüntüleme ve karotis doppler ultrasonografi tetkik sonuçları; Acil servis sonuçları (hastaneye yatış, taburculuk), risk grubu dağılımı (ABCD2 puanlarına göre) ve bir yıllık tekrar olay insidansına ilişkin değişkenler karşılaştırıldı. Ayrıca hastaların serum kopeptin düzeyleri sağlıklı kontrollerle karşılaştırıldı. Bulgular Ortalama kopeptin düzeyi hasta grubunda 435.80 ± 316.45 pg/ml iken kontrol grubunda 770.20 ± 912.53 pg/ml idi. TİA'lı hastaların ortalama kopeptin düzeyi anlamlı olarak daha düşüktü (p = 0.018). TİA tanısında tüm katılımcılarda kopeptin 386.28 pg/ml cut-off değerinde %60.53 duyarlılık ve %68.42 özgüllüğe sahipti. Ayrıca 60 yaş üstü katılımcılarda kopeptin 460.37 pg/ml cut-off değerinde %75.86 duyarlılık ve %72.41 özgüllüğe sahipti. Sonuç Bildiğimiz kadarıyla bu, bir serum biyobelirteçlerinin TİA tanısında yüksek etkinliğini gösteren ilk çalışmadır. Klinik şüphesi düşük ve kopeptin değeri düşük olan hastalarda acil hekimleri alternatif tanıları araştırmalıdır.

Anahtar Kelimeler:

Arginin-vazopressin, Kopeptin, Acil, Nöroloji, Geçici İskemik Atak

SERUM COPEPTIN LEVEL AS A BIOMARKER FOR DETECTING TRANSIENT ISCHEMIC ATTACK IN THE EMERGENCY ROOM: A PROSPECTIVE CASE-CONTROL STUDY

Objective We aimed to investigate the diagnostic accuracy of copeptin to detect transient ischemic attack (TIA) by comparing the plasma copeptin levels of patients diagnosed with TIA who were admitted to the Emergency Department (ED) with those of healthy controls. Materials and Methods We conducted a prospective case-control study among patients admitted to the ED with a neurological symptom. The patients diagnosed with TIA by the neurologist were included. The results of electrocardiography, magnetic resonance imaging, and carotid doppler ultrasonography investigations of 38 patients; the ED outcomes (hospitalization, discharge), the risk group distribution (according to ABCD2 scores), and the variables regarding one-year re-event incidence were compared. Additionally, the serum copeptin levels of the patients were compared to those of healthy controls. Results The mean copeptin level was 435.80 ± 316.45 pg/ml in the patient group, whereas it was 770.20 ± 912.53 pg/ml in the control group. The mean copeptin level of patients with TIA was significantly lower (p = 0.018). In the diagnosis of TIA, copeptin had 60.53% sensitivity and 68.42% specificity at a cut-off value of 386.28 pg/ ml, in all the participants. In addition, in participants above 60 years old, copeptin had 75.86% sensitivity and 72.41% specificity at a cut-off value of 460.37 pg/ ml. Conclusion To the best of our knowledge, this is the first study demonstrating the high efficacy of a serum biomarker in the diagnosis of TIA. Emergency physicians should search for alternative diagnoses in patients with a low degree of clinical suspicion and a lower copeptin value.

Keywords:

Arginine-vasopressin, Copeptin, Emergency, Neurology, Transient Ischemic Attack,

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