Nonspecific stress biomarkers for mortality prediction in older emergency department patients presenting with falls: a prospective multicenter observational study.

IF 3.2 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Internal and Emergency Medicine Pub Date : 2025-03-01 Epub Date: 2024-07-03 DOI:10.1007/s11739-024-03693-6

Lukas Terhalle, Laura Arntz, Felix Hoffmann, Isabelle Arnold, Livia Hafner, Laurentia Picking-Pitasch, Joanna Zuppinger, Karen Delport Lehnen, Jörg Leuppi, Rajan Somasundaram, Christian H Nickel, Roland Bingisser

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引用次数: 0

Abstract

Background: Older patients presenting to the emergency department (ED) after falling are increasingly prevalent. Falls are associated with functional decline and death. Biomarkers predicting short-term mortality might facilitate decisions regarding resource allocation and disposition. D-dimer levels are used to rule out thromboembolic disease, while copeptin and adrenomedullin (MR-proADM) may be used as measures of the patient`s stress level. These nonspecific biomarkers were selected as potential predictors for mortality.

Methods: Prospective, international, multicenter, cross-sectional observation was performed in two tertiary and two regional hospitals in Germany and Switzerland. Patients aged 65 years or older presenting to the ED after a fall were enrolled. Demographic data, Activities of Daily Living (ADL), and D-dimers were collected upon presentation. Copeptin and MR-proADM levels were determined from frozen samples. Primary outcome was 30-day mortality; and secondary outcomes were mortality at 90, 180, and 365 days.

Results: Five hundred and seventy-two patients were included. Median age was 83 [IQR 78, 89] years, 236 (67.7%) were female. Mortality overall was 3.1% (30 d), 5.4% (90 d), 7.5% (180 d), and 13.8% (365 d), respectively. Non-survivors were older, had a lower ADL index and higher levels of all three biomarkers. Elevated levels of MR-proADM and D-dimer were associated with higher risk of mortality. MR-proADM and D-dimer showed high sensitivity and low negative likelihood ratio regarding short-term mortality, whereas copeptin did not.

Conclusion: D-dimer and MR-proADM levels might be useful as prognostic markers in older patients presenting to the ED after a fall, by identifying patients at low risk of short-term mortality.

Trial registration: ClinicalTrials.gov Identifier: NCT02244983.

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预测急诊科跌倒的老年患者死亡率的非特异性应激生物标志物：一项前瞻性多中心观察研究。

背景：跌倒后到急诊科（ED）就诊的老年患者越来越多。跌倒与功能衰退和死亡有关。预测短期死亡率的生物标志物可能有助于做出资源分配和处置决定。D 二聚体水平可用于排除血栓栓塞性疾病，而 copeptin 和肾上腺髓质素（MR-proADM）可用于衡量患者的应激水平。这些非特异性生物标志物被选为预测死亡率的潜在指标：在德国和瑞士的两家三级医院和两家地区医院进行了前瞻性、国际性、多中心、横断面观察。患者年龄在 65 岁或以上，跌倒后到急诊室就诊。在患者就诊时收集其人口统计学数据、日常生活活动（ADL）数据和 D-二聚体数据。通过冷冻样本测定谷肽和MR-proADM水平。主要结果是 30 天的死亡率；次要结果是 90 天、180 天和 365 天的死亡率：共纳入 572 名患者。中位年龄为 83 [IQR 78, 89] 岁，女性 236 人（67.7%）。总死亡率分别为 3.1%（30 天）、5.4%（90 天）、7.5%（180 天）和 13.8%（365 天）。非幸存者年龄较大，ADL指数较低，三种生物标志物水平均较高。MR-proADM 和 D-二聚体水平升高与较高的死亡风险有关。MR-proADM和D-二聚体对短期死亡率的敏感性高、负似然比低，而 copeptin 则不然：结论：D-二聚体和MR-proADM水平可作为跌倒后到急诊室就诊的老年患者的预后标志物，识别短期死亡风险较低的患者：试验注册：ClinicalTrials.gov Identifier：试验注册：ClinicalTrials.gov Identifier：NCT02244983。

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来源期刊

Internal and Emergency Medicine 医学-医学：内科

CiteScore

7.20

自引率

4.30%

发文量

258

审稿时长

6-12 weeks

期刊介绍： Internal and Emergency Medicine (IEM) is an independent, international, English-language, peer-reviewed journal designed for internists and emergency physicians. IEM publishes a variety of manuscript types including Original investigations, Review articles, Letters to the Editor, Editorials and Commentaries. Occasionally IEM accepts unsolicited Reviews, Commentaries or Editorials. The journal is divided into three sections, i.e., Internal Medicine, Emergency Medicine and Clinical Evidence and Health Technology Assessment, with three separate editorial boards. In the Internal Medicine section, invited Case records and Physical examinations, devoted to underlining the role of a clinical approach in selected clinical cases, are also published. The Emergency Medicine section will include a Morbidity and Mortality Report and an Airway Forum concerning the management of difficult airway problems. As far as Critical Care is becoming an integral part of Emergency Medicine, a new sub-section will report the literature that concerns the interface not only for the care of the critical patient in the Emergency Department, but also in the Intensive Care Unit. Finally, in the Clinical Evidence and Health Technology Assessment section brief discussions of topics of evidence-based medicine (Cochrane’s corner) and Research updates are published. IEM encourages letters of rebuttal and criticism of published articles. Topics of interest include all subjects that relate to the science and practice of Internal and Emergency Medicine.