Association of physiological stress markers at the emergency department to readmission and death within 90 days: a prospective observational study.

Autor: Davidson LT; Department of Emergency Medicine in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden., Schilling UM; Department of Urgent Care in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden., Arnqvist HJ; Department of Endocrinology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden., Nystrom FH; Department of Endocrinology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden., Chisalita SI; Department of Endocrinology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Jazyk: angličtina
Zdroj: Upsala journal of medical sciences [Ups J Med Sci] 2023 May 03; Vol. 128. Date of Electronic Publication: 2023 May 03 (Print Publication: 2023).
DOI: 10.48101/ujms.v128.9300
Abstrakt: Background: Predicting the risk of readmission or death in patients at the emergency department (ED) is essential in identifying patients who would benefit the most from interventions. We aimed to explore the prognostic value of mid-regional proadrenomedullin (MR-proADM), mid-regional pro-atrial natriuretic peptide (MR-proANP), copeptin, and high-sensitivity troponin T (hs-TnT) to identify patients with a higher risk of readmission and death among patients presenting with chest pain (CP) and/or shortness of breath (SOB) in the ED.
Methods: This single-center prospective observational study included non-critically ill adult patients with a chief complaint of CP and/or SOB who visited the ED at Linköping University Hospital. Baseline data and blood samples were collected, and patients were followed up for 90 days after inclusion. The primary outcome was a composite of readmission and/or death from non-traumatic causes within 90 days of inclusion. Binary logistic regression was used and receiver operating characteristics (ROC) curves were constructed to determine the prognostic performance for predicting readmission and/or death within 90 days.
Results: A total of 313 patients were included and 64 (20.4%) met the primary endpoint. MR-proADM > 0.75 pmol/L (odds ratio [OR]: 2.361 [95% confidence interval [CI]: 1.031 - 5.407], P = 0.042) and multimorbidity (OR: 2.647 [95% CI: 1.282 - 5.469], P = 0.009) were significantly associated with readmission and/or death within 90 days. MR-proADM increased predictive value in the ROC analysis to age, sex, and multimorbidity ( P = 0.006).
Conclusions: In non-critically ill patients with CP and/or SOB in the ED, MR-proADM and multimorbidity may be helpful for the prediction of the risk of readmission and/or death within 90 days.
Competing Interests: Authors declare no conflict of interest.
(© 2023 The Author(s). Published by Upsala Medical Society.)
Databáze: MEDLINE
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