الفهرس 
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Abstract
Globally, stroke is the second leading cause of death between 1990 and 2010.It is the most common cause of permanent disability (Rothwell et al., 2005). In Egypt, the overall prevalence rate of stroke is high with a crude prevalence rate of 963/100 000 inhabitants (Abdallah et al, 2014).It is one of the leading causes of severe morbidity. It is also associated with high stress response in the body which may lead to secondary brain damage and worse prognosis (Wang et al., 2016).
Copeptin, a peptide of 39 amino acids, is the C-terminal part of pro- AVP and is released together with AVP during processing of the precursor peptide (Katan et al, 2008). The main physiological functions of AVP are the homeostasis of fluid balance and the regulation of vascular tone and the endocrine stress response. copeptin is stable both in serum and plasma at room temperature and can be easily measured ex vivo as a ‘shadow’ fragment of AVP in the circulation in manual or fully automated chemiluminescence assays. Copeptin results are available within one hour, which is crucial for any useful biomarker in the emergency department (ED) setting. (Reinstadler SJ et al, 2015).
Recently there has been increasing interest in vasopressin because it is implicated in inflammation, cerebral edema, increased intracerebral pressure, and cerebral ion and neurotransmitter dysfunctions after cerebral ischemia. (Qian Xu et al, 2017). It is increasingly being recognized that copeptin predicts adverse outcomes in patients with stroke. Brain injury, including ischemia, causes the release of stress hormones such as AVP. Vasopressin, an acute-phase reactant, is released after brain injury and is partially responsible for the subsequent inflammatory response via activation of divergent pathways.
The aim of this work is to assess the role of copeptin level in plasma as a biomarker for early diagnosis and prognosis of acute ischemic stroke in a sample of stroke patients in Beni-Suef governorate, north Upper Egypt.
This study is a case control study that included 90 subjects, 45 patients with first ever acute ischemic stroke defined according to the World Health Organization criteria and with symptom onset within 24h selected from emergency room and outpatient clinic in Beni-Suef University Hospital and 45 healthy patients of matched age and sex chosen as control group during the period between December 2018 and September 2019.
All patients of the study were subjected to the following:
1- Careful history taking: focusing on demographic data (age and sex) and history of risk factors of ischemic stroke.
2- Thorough general examination: including vital signs and cardiac assessment.
3- Thorough neurological examinations according to the neurovascular sheet currently used in neurology department, Beni-Suef University.
4- The patients were classified by The TOAST classification.
5- The patients were evaluated by NIHSS (national institute of health stroke scale) at presentation.
6- Functional outcome were assessed on day 90 using the modified Rankin Scale (mRS) score.
7- Laboratory investigation included:
A-Routine laboratory investigations B-Evaluation of copeptin level
8- Radiological assessment included: A-CT Brain or MRI brain
B-ECG and Echocardiography
C-Carotid and vertebro-basilar duplex
The results of this work can be summarized in these points:
-serum copeptin levels were much higher in patients with acute ischemic stroke compared to healthy controls (P-value 0.001)
- Serum copeptin level when measured within 24 hours of stroke onset was correlated significantly with the stroke severity according to (NIHSS) on admission and patients with severe stroke had higher copeptin level than patients with mild to moderate stroke (P-value 0.001).
- Serum copeptin level has statistically positive correlation with the initial infarction volume measured on CT brain or MRI brain (P-value 0.001).
-patients with higher the mRS score had higher the copeptin levels. Also copeptin level was much higher in stroke patients with unfavorable outcome (mRS=3-6) than stroke patients with favorable outcome (mRS=0- 2) (P-value 0.001).
-there was a significant positive correlations between copeptin level and patient’s age p-value 0.045, BMI p-value 0.009, serum uric acid, cholesterol and TG levels (P-value 0.01).
- Serum Copeptin level was significantly higher in Patients with HTN as compared with patients without HTN (P-value 0.05).
- Acute stroke patients with DM had significantly higher copeptin level as compared with patients without DM (P-value 0.024).
- Insignificant difference was found between male and female stroke patients regarding copeptin level (P-value 0.169).
- No statistically significant difference was found between cardiac patients and their counterparts who did not have cardiac disease regarding copeptin level (P-value 0.547).
- Copeptin was not significantly different in subjects who had normal carotid artery (P-value 0.728).
- Copeptin level was significantly lower in patients received rTPA as compared with patients who did not receive rTPA (P-value 0.049).
- No significant correlation between serum copeptin level and site of infarction (P-value 0.679).
- No statistically significant difference between the mean value of copeptin level and the etiological subtypes of stroke in the studied groups regarding TOAST classification (P-value 0.290).