The "COSMOS"-Study (Copeptin in Osmoregulation and Stress Assessment)

Sodium imbalance is common and an adverse prognostic factor in hospitalized patients. However, identifying the causes of sodium imbalance is challenging in clinical practice. Levels of antidiuretic hormone (ADH) are elevated in patients with stroke correlating with disease severity and stress level; however, its measurement is cumbersome. ADH is derived from a larger precursor peptide along with Copeptin, which is a more stable peptide directly mirroring the production of ADH. Copeptin can be assayed readily in plasma. Early prognostic factors to predict in-hospital mortality and medium/long-term outcome in critically ill neurological patients, are helpful to guide and tailor early decisions on treatment, discharge from the intensive care unit and application of interventions to prevent deterioration of neurological functions. We hypothesize that copeptin will improve the diagnostic accuracy to diagnose sodium imbalances as compared to routinely used markers Furthermore, we hypothesize that Copeptin will be a reliable prognostic tool, dependent or independent of sodium imbalance, to predict short-term (i.e. in-hospital) and medium-term (i.e. 3 months) clinical outcome in stroke patients.

Sex

All

Inclusion Criteria:

1. All consecutive patients who are admitted to the emergency department with an ischemic or hemorrhagic stroke or transient ischemic attach (TIA) according to the World Health organization criteria \[37\] with symptom onset within the last 3 days.
2. All consecutive patients who undergo intracranial surgery due to

   * pituitary tumors
   * intracerebral hemorrhage (ICH)
   * subarachnoidal hemorrhage (SAH)
   * chronic subdural hematoma
   * head trauma with contusion cerebri
   * intracranial abcesses

Exclusion Criteria:

* Patients without informed consent.

• DERIVEDSchweizer J, Bustamante A, Lapierre-Fetaud V, Faura J, Scherrer N, Azurmendi Gil L, Fluri F, Schutz V, Luft A, Boned S, Sanchez JC, Montaner J, Katan M. SAA (Serum Amyloid A): A Novel Predictor of Stroke-Associated Infections. Stroke. 2020 Dec;51(12):3523-3530. doi: 10.1161/STROKEAHA.120.030064. Epub 2020 Nov 9. PMID 33161846
• DERIVEDDe Marchis GM, Dankowski T, Konig IR, Fladt J, Fluri F, Gensicke H, Foerch C, Findling O, Kurmann R, Fischer U, Luft A, Buhl D, Engelter ST, Lyrer PA, Christ-Crain M, Arnold M, Katan M. A novel biomarker-based prognostic score in acute ischemic stroke: The CoRisk score. Neurology. 2019 Mar 26;92(13):e1517-e1525. doi: 10.1212/WNL.0000000000007177. Epub 2019 Mar 1. PMID 30824558
• DERIVEDNigro N, Wildi K, Mueller C, Schuetz P, Mueller B, Fluri F, Christ-Crain M, Katan M. BNP but Not s-cTnln is associated with cardioembolic aetiology and predicts short and long term prognosis after cerebrovascular events. PLoS One. 2014 Jul 29;9(7):e102704. doi: 10.1371/journal.pone.0102704. eCollection 2014. PMID 25072816
• DERIVEDFrontzek K, Fluri F, Siemerkus J, Muller B, Gass A, Christ-Crain M, Katan M. Isolated insular strokes and plasma MR-proANP levels are associated with newly diagnosed atrial fibrillation: a pilot study. PLoS One. 2014 Mar 19;9(3):e92421. doi: 10.1371/journal.pone.0092421. eCollection 2014. PMID 24647802
• DERIVEDBlum CA, Mueller C, Schuetz P, Fluri F, Trummler M, Mueller B, Katan M, Christ-Crain M. Prognostic value of dehydroepiandrosterone-sulfate and other parameters of adrenal function in acute ischemic stroke. PLoS One. 2013 May 1;8(5):e63224. doi: 10.1371/journal.pone.0063224. Print 2013. PMID 23650556
• DERIVEDZweifel C, Katan M, Schuetz P, Ernst A, Mariani L, Muller B, Christ-Crain M. Growth hormone and outcome in patients with intracerebral hemorrhage: a pilot study. Biomarkers. 2011 Sep;16(6):511-6. doi: 10.3109/1354750X.2011.599074. Epub 2011 Aug 3.