Prognostic value of different biomarkers for cardiovascular death in unselected older patients in the emergency department

Beitrag in einer Fachzeitschrift


Details zur Publikation

Autorinnen und Autoren: Bahrmann P, Christ M, Hofner B, Bahrmann A, Achenbach S, Sieber C, Bertsch T
Zeitschrift: European Heart Journal: Acute Cardiovascular Care
Jahr der Veröffentlichung: 2016
Band: 5
Heftnummer: 8
Seitenbereich: 568-578
ISSN: 2048-8726
eISSN: 2048-8726


Abstract

Risk stratification of elderly patients presenting with heart failure (HF) to an emergency department (ED) is an unmet challenge. We prospectively investigated the prognostic performance of different biomarkers in unselected older patients in the ED.We consecutively enrolled 302 non-surgical patients ?70 years presenting to the ED with a wide range of cardiovascular and non-cardiovascular comorbid conditions. N-terminal pro-B-type natriuretic peptide (NT-proBNP), mid-regional pro-adrenomedullin (MR-proADM), mid-regional pro-atrial natriuretic peptide (MR-proANP), C-terminal pro-endothelin-1 (CT-proET-1), ultrasensitive C-terminal pro-arginine-vasopressin (Copeptin-us) and high-sensitivity cardiac troponin T (hs-cTnT) were measured at admission. Two cardiologists independently adjudicated the final diagnosis of HF after reviewing all available baseline data using circulating NT-proBNP levels. A final diagnosis of HF was found in 120 (40%) of the 302 patients. All patients were followed up for cardiovascular death within the following 12 months. In order to test the prognostic performance of the investigated biomarkers we used boosting models with age and sex as mandatory covariates. Boosting is a statistical learning technique with built-in variable selection developed to obtain sparse and interpretable prediction models.Follow-up was 100% complete. During a median follow-up time of 225 days (interquartile range (IQR) 156-319 days), 30 (9.9%) of 302 patients (aged 81±6 years) had cardiovascular deaths. Of these 30 patients, 21 had HF and nine had no HF diagnosed prior to admission. The boosting model selected MR-proADM and hs-cTNT as predictors of cardiovascular deaths. The median values of MR-proADM and hs-cTnT at presentation were significantly higher in patients with cardiovascular deaths compared to surviving patients during follow-up (2.56 nmol/L (IQR 1.62-4.48) vs. 1.11 nmol/L (IQR 0.83-1.80), P<0.001 and 81 ng/L (IQR 38-340) vs. 17 ng/L (IQR 0.9-38), P=0.004). One unit increase in the log-transformed MR-proADM levels was associated with a 1.99-fold risk of death (95% confidence interval (CI) 1.61-2.45, P<0.001). The second marker, hs-cTnT, showed an increased predicted risk but was not significantly correlated to event-free survival (hazard ratio 3.22, 95% CI 0.97-10.68, P=0.056).Within different biomarkers, MR-proADM was the only predictor of cardiovascular deaths in unselected older patients presenting to the ED.


FAU-Autorinnen und Autoren / FAU-Herausgeberinnen und Herausgeber

Achenbach, Susanne Dr. med.
Transfusionsmedizinische und Hämostaseologische Abteilung in der Chirurgischen Klinik
Bahrmann, Philipp PD Dr.
Medizinische Fakultät
Hofner, Benjamin PD Dr.
Lehrstuhl für Biometrie und Epidemiologie
Sieber, Cornel Prof. Dr.
Lehrstuhl für Innere Medizin (Geriatrie)


Einrichtungen weiterer Autorinnen und Autoren

Paracelsus Medizinische Privatuniversität
Universitätsklinikum Heidelberg


Zitierweisen

APA:
Bahrmann, P., Christ, M., Hofner, B., Bahrmann, A., Achenbach, S., Sieber, C., & Bertsch, T. (2016). Prognostic value of different biomarkers for cardiovascular death in unselected older patients in the emergency department. European Heart Journal: Acute Cardiovascular Care, 5(8), 568-578. https://dx.doi.org/10.1177/2048872615612455

MLA:
Bahrmann, Philipp, et al. "Prognostic value of different biomarkers for cardiovascular death in unselected older patients in the emergency department." European Heart Journal: Acute Cardiovascular Care 5.8 (2016): 568-578.

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Zuletzt aktualisiert 2018-10-10 um 02:19