Stress Markers Predict Mortality in Patients With Nonspecific Complaints Presenting to the Emergency Department and May Be a Useful Risk Stratification Tool to Support Disposition Planning
| Autor: | Sabine Hertel, Sven Giersdorf, Christian H. Nickel, Frank Dusemund, Roland Bingisser, Beat Mueller, Franziska Misch, Nicolas Geigy, Oliver Hartmann, Anna S. Messmer |
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| Rok vydání: | 2013 |
| Předmět: |
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medicine.medical_specialty Hospital mortality medicine.disease_cause Risk Assessment Sensitivity and Specificity Hospitals University Adrenomedullin Predictive Value of Tests Cause of Death Humans Medicine Psychological stress In patient Hospital Mortality Geriatric Assessment Fatigue Aged Proportional Hazards Models Aged 80 and over Gynecology Analysis of Variance Chi-Square Distribution business.industry Glycopeptides Geriatric assessment Peroxiredoxins General Medicine Length of Stay Survival Analysis Cross-Sectional Studies Chronic disease Acute Disease Chronic Disease Multivariate Analysis Risk stratification Emergency Medicine Female Emergency Service Hospital business Algorithms Biomarkers Stress Psychological Switzerland |
| Zdroj: | Academic Emergency Medicine. 20:670-679 |
| ISSN: | 1069-6563 |
| DOI: | 10.1111/acem.12172 |
| Popis: | Objectives To the authors’ knowledge, no prospectively validated, biomarker-based risk stratification tools exist for elderly patients presenting to the emergency department (ED) with nonspecific complaints (NSCs), such as generalized weakness, despite the fact that an acute serious disease often underlies nonspecific disease presentation. The primary purpose for this study was to validate the retrospectively derived model for outcome prediction using copeptin and peroxiredoxin 4 (Prx4), in a different group of patients, in a prospective fashion, in a multicenter setting. The secondary goals were to evaluate the potential contribution of the midregional portion of the precursor of adrenomedullin (MR-proADM) for outcome prediction and to investigate whether disposition decisions show promise for potential improvement by using biomarker levels in addition to a clinical assessment. Methods The Basel Nonspecific Complaints (BANC) study is a delayed-type cross-sectional diagnostic study, carried out in three EDs in Switzerland, with a prospective 30-day follow-up. Patients presenting to the ED with NSCs, as defined previously, were included if their vital signs were within predefined limits. Measurement of biomarkers was performed in serum samples with sandwich immunoluminometric assays. To examine the disposition process, the final disposition was compared with a combination of the first clinical disposition decision and the risk assessment, which included the biomarker MR-proADM in a retrospective simulation. Patients were divided into three groups according to MR-proADM concentration, defining three risk classes with three disposition possibilities (admission to tertiary care, transfer to geriatric hospital, discharge). Results Thirty-three 30-day nonsurvivors were observed from among 504 study patients with NSCs. Biomarker levels were significantly greater in nonsurvivors than survivors (p |
| Databáze: | OpenAIRE |
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