Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

Blum, Claudine Angela and Winzeler, Bettina and Nigro, Nicole and Schuetz, Philipp and Biethahn, Silke and Kahles, Timo and Mueller, Cornelia and Timper, Katharina and Haaf, Katharina and Tepperberg, Janina and Amort, Margareth and Huber, Andreas and Bingisser, Roland and Sándor, Peter Stephan and Nedeltchev, Krassen and Müller, Beat and Katan, Mira and Christ-Crain, Mirjam. (2017) Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study. Journal of Headache and Pain, 18 (1). p. 21.

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In the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out. Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting.; Patients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study. Copeptin was measured upon presentation to the emergency department. Primary endpoint was serious secondary headache defined by a neurologic cause requiring immediate treatment of the underlying disease. Secondary endpoint was the combination of mortality and hospitalization within 3 months. Two board-certified neurologist blinded to copeptin levels verified the endpoints after a structured 3-month-telephone interview.; Of the 391 patients included, 75 (19%) had a serious secondary headache. Copeptin was associated with serious secondary headache (OR 2.03, 95%CI 1.52-2.70, p < 0.0001). Area under the curve (AUC) for copeptin to identify the primary endpoint was 0.70 (0.63-0.76). After adjusting for age > 50, focal-neurological abnormalities, and thunderclap onset of symptoms, copeptin remained an independent predictive factor for serious secondary headache (OR 1.74, 95%CI 1.26-2.39, p = 0.001). Moreover, copeptin improved the AUC of the multivariate logistic clinical model (p-LR-test < 0.001). Even though copeptin values were higher in patients reaching the secondary endpoint, this association was not significant in multivariate logistic regression.; Copeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.; Study Registration on 08/02/2010 as NCT01174901 at clinicaltrials.gov.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Endokrinologie / Diabetologie > Endokrinologie (Christ-Crain)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Endokrinologie / Diabetologie > Endokrinologie (Christ-Crain)
UniBasel Contributors:Christ-Crain, Mirjam
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Springer Verlag
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:05 Oct 2017 08:13
Deposited On:05 Oct 2017 08:12

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