Value of biomarkers in predicting mortality in older medical emergency department patients: a Dutch prospective study.

Autor:	Zelis N; Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands.; Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, Limburg, The Netherlands., Hundscheid R; Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands., Buijs J; Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands., De Leeuw PW; Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands.; Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, Limburg, The Netherlands.; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, Limburg, The Netherlands., Raijmakers MT; Laboratory of Clinical Chemistry and Haematology, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands., van Kuijk SM; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht University, Maastricht, Limburg, The Netherlands., Stassen PM; Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, Limburg, The Netherlands p.stassen@mumc.nl.; School of CAPHRI, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2021 Jan 31; Vol. 11 (1), pp. e042989. Date of Electronic Publication: 2021 Jan 31.
DOI:	10.1136/bmjopen-2020-042989
Abstrakt:	Objective: Older emergency department (ED) patients are at high risk of mortality, and it is important to predict which patients are at highest risk. Biomarkers such as lactate, high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), D-dimer and procalcitonin may be able to identify those at risk. We aimed to assess the discriminatory value of these biomarkers for 30-day mortality and other adverse outcomes. Design: Prospective cohort study. On arrival of patients, five biomarkers were measured. Area under the curves (AUCs) and interval likelihood ratios (LRs) were calculated to investigate the discriminatory value of the biomarkers. Setting: ED in the Netherlands. Participants: Older (≥65 years) medical ED patients, referred for internal medicine or gastroenterology. Primary and Secondary Outcome Measures: 30-day mortality was the primary outcome measure, while other adverse outcomes (intensive care unit/medium care unit admission, prolonged length of hospital stay, loss of independent living and unplanned readmission) were the composite secondary outcome measure. Results: The median age of the 450 included patients was 79 years (IQR 73-85). In total, 51 (11.3%) patients died within 30 days. The AUCs of all biomarkers for prediction of mortality were sufficient to good, with the highest AUC of 0.73 for hs-cTnT and NT-proBNP. Only for the highest lactate values, the LR was high enough (29.0) to be applicable for clinical decision making, but this applied to a minority of patients. The AUC for the composite secondary outcome (intensive and medium care admission, length of hospital stay >7 days, loss of independent living and unplanned readmission within 30 days) was lower, ranging between 0.58 and 0.67. Conclusions: Although all five biomarkers predict 30-day mortality in older medical ED patients, their individual discriminatory value was not high enough to contribute to clinical decision making. Trial Registration Number: NCT02946398; Results. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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