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

Background 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 seco...

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Published in:Journal of headache and pain 2017-12, Vol.18 (1), p.21, Article 21
Main Authors: Blum, Claudine Angela, Winzeler, Bettina, Nigro, Nicole, Schuetz, Philipp, Biethahn, Silke, Kahles, Timo, Mueller, Cornelia, Timper, Katharina, Haaf, Katharina, Tepperberg, Janina, Amort, Margareth, Huber, Andreas, Bingisser, Roland, Sándor, Peter Stephan, Nedeltchev, Krassen, Müller, Beat, Katan, Mira, Christ-Crain, Mirjam
Format: Article
Language:English
Subjects:
Acute Disease
Aged
Area Under Curve
Biomarkers
Biomarkers - blood
Emergency Service, Hospital
Female
Follow-Up Studies
Glycopeptides - blood
Headache - blood
Headache - diagnosis
Headache - physiopathology
Headaches
Humans
Internal Medicine
Male
Medicine
Medicine & Public Health
Middle Aged
Neurology
Pain
Pain Medicine
Predictive Value of Tests
Prospective Studies
Research Article
Risk Assessment
Studies
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Summary:Background 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. Methods 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. Results 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   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 
ISSN:1129-2369
1129-2377
DOI:10.1186/s10194-017-0733-2