Copeptin as a serum biomarker of febrile seizures

Benjamin Stöcklin, Sotirios Fouzas, Paula Schillinger, Sevgi Cayir, Roswitha Skendaj, Michel Ramser, Peter Weber, Sven Wellmann, Benjamin Stöcklin, Sotirios Fouzas, Paula Schillinger, Sevgi Cayir, Roswitha Skendaj, Michel Ramser, Peter Weber, Sven Wellmann

Abstract

Background and objectives: Accurate diagnosis of febrile seizures in children presenting after paroxysmal episodes associated with fever, is hampered by the lack of objective postictal biomarkers. The aim of our study was to investigate whether FS are associated with increased levels of serum copeptin, a robust marker of arginine vasopressin secretion.

Methods: This was a prospective emergency-setting cross-sectional study of 161 children between six months and five years of age. Of these, 83 were diagnosed with febrile seizures, 69 had a febrile infection without seizures and nine had epileptic seizures not triggered by infection. Serum copeptin and prolactin levels were measured in addition to standard clinical, neurophysiological, and laboratory assessment.

Clinical trial registration: NCT01884766.

Results: Circulating copeptin was significantly higher in children with febrile seizures (median [interquartile range] 18.9 pmol/L [8.5-36.6]) compared to febrile controls (5.6 pmol/L [4.1-9.4]; p < 0.001), with no differences between febrile and epileptic seizures (21.4 pmol/L [16.1-46.6]; p = 0.728). In a multivariable regression model, seizures were the major determinant of serum copeptin (beta 0.509; p < 0.001), independently of clinical and baseline laboratory indices. The area under the receiver operating curve for copeptin was 0.824 (95% CI 0.753-0.881), significantly higher compared to prolactin (0.667 [0.585-0.742]; p < 0.001). The diagnostic accuracy of copeptin increased with decreasing time elapsed since the convulsive event (at 120 min: 0.879 [0.806-0.932] and at <60 min: 0.975 [0.913-0.997]).

Conclusions: Circulating copeptin has high diagnostic accuracy in febrile seizures and may be a useful adjunct for accurately diagnosing postictal states in the emergency setting.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Scatter dot plots of serum…
Fig 1. Scatter dot plots of serum copeptin and prolactin values in the three study groups.
Medians and interquartile ranges are also presented. Between-group comparisons were performed with Mann-Whitney U test. * Serum copeptin values in 4 cases (range 208–306 pmol/L) are outside the copeptin-axis limits of the graph. FS: febrile seizures; ES: epileptic seizures
Fig 2. Receiver operating characteristic curves of…
Fig 2. Receiver operating characteristic curves of serum copeptin and prolactin.
(A) In controls (n = 69) and in children with febrile seizures irrespectively to the time of presentation (n = 83); (B) In controls (n = 69) and in children with febrile seizures presented

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Source: PubMed

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