Study with Copeptin as predictor of outcome in patients with a subarachnoid haemorrhage from a ruptured cerebral aneurysm.

SUMMARY
Background

Subarachnoid haemorrhage from a ruptured cerebral aneurysm (aSAH) is a significant cause of mortality and morbidity throughout the world. Multiple clinically grading scales are developed to indicate the severity of neurological injury, and to provide prognostic information regarding outcome. However, prediction of outcome remains difficult and complicates decision making for active treatment. Copeptin, the C-terminal part of the arginine vasopressin precursor peptide, is associated with the severity and outcome of critical illness. Recently it has been reported that initial high levels of copeptin in blood are highly predictive for poor outcome and vasospasm in patients presenting with aSAH in the Chinese population.

Objective

The aim of this prospective study is to elucidate whether copeptin could be used as a marker for prognosis and severity of aSAH in Dutch intensive care populations?

Study design

A single center prospective observational study

Study population

Patients admitted to the ICU of the St. Elisabeth Hospital with an age of 18 years or over with clinical symptoms of SAH within 24 hours at admission in which a cerebral aneurysm is confirmed by computerized tomography angiography (CT-A) with or without digital substraction angiography (DSA).

Intervention

After informed consent is obtained blood will be drawn in an serum tube of 5 ml on the first 24 hours of admission at de ICU for copeptin levels in the aSAH group. Included aSAH patients will be evaluated for delayed cerebral ischaemia (DCI). 30 days and 12 months after the aSAH, alive patients will be contacted by the research nurse for a questionnaire by telephone, including the Glasgow Outcome Scale (GOS) and the modified Ranking Scale (mRS). In a control group of 30 healthy volunteers without cardiovascular risk factors and without any neurological deficits of copeptin levels will be estimated to compare these results with the copeptin levels of the included aSAH patients.

Main outcome measurement

Poor one-year functional outcome, GOS 1-3, development of DCI, case fatality 30 days after admission, one year mortality and functional outcome 12 months after aSAH, assessed by both Glasgow Outcome Scale and the modified Ranking Scale.

Could copeptin be used as a marker for prognosis and severity of aSAH in Dutch intensive care populations?

30 days and 12 months after the aSAH, the general practitioner of the patient will be contacted to check whether the patient is still alive. After 12 months alive patients will be contacted by the research nurse for a questionnaire by telephone.

For copeptin levels in the aSAH group, blood will be drawn in an extra serum tube of 5 ml on the first 24 hours of admission at the ICU.