Cardiometabolic biomarkers are predictors of readmission and death in patients hospitalized for acute dyspnea
(2016) In American Journal of Emergency Medicine 35(4). p.610-614- Abstract
BACKGROUND: Acute dyspnea affects a large heterogeneous patient group with high mortality and readmission rates.
PURPOSE: To investigate if cardiometabolic biomarkers and clinical characteristics predict readmission and death in patients hospitalized for acute dyspnea.
METHODS: 65 dyspnea patients at a general internal medicine ward were followed for six months. The combined endpoint was readmission or death.
MEASUREMENTS AND RESULTS: Cardiometabolic biomarkers at admission were related to the endpoint in Cox proportional hazard models (adjusted for sex, age, oxygen saturation, respiratory rate and C-reactive protein (CRP)). The biomarkers tissue-type plasminogen activator (tPA), prolactin (PRL), tumor necrosis factor... (More)
BACKGROUND: Acute dyspnea affects a large heterogeneous patient group with high mortality and readmission rates.
PURPOSE: To investigate if cardiometabolic biomarkers and clinical characteristics predict readmission and death in patients hospitalized for acute dyspnea.
METHODS: 65 dyspnea patients at a general internal medicine ward were followed for six months. The combined endpoint was readmission or death.
MEASUREMENTS AND RESULTS: Cardiometabolic biomarkers at admission were related to the endpoint in Cox proportional hazard models (adjusted for sex, age, oxygen saturation, respiratory rate and C-reactive protein (CRP)). The biomarkers tissue-type plasminogen activator (tPA), prolactin (PRL), tumor necrosis factor receptor superfamily member 6 (FAS) and C-C motif chemokine 3 (CCL3) were independently and significantly related to the endpoint and combined into a biomarker risk score (BRS). Each SD increment of the BRS conferred a hazard ratio (HR) of 2.13 (1.39-3.27) P=0.001. The top vs bottom tertile of the BRS conferred a HR of 4.75 (1.93-11.68) P=0.001. Dyspnea severity was also associated with worse outcome, HR=3.43 (1.28-9.20) P=0.014. However, when mutually adjusted the BRS remained significant (P=0.004) whereas dyspnea severity was not. The BRS was related to the endpoint among patients with mild to moderate dyspnea (P=0.016) but not among those with severe dyspnea.
CONCLUSION: A score of tPA, PRL, FAS and CCL3 predicts 6-month death and readmission in patients hospitalized for acute dyspnea and may prove useful to optimize length of stay and follow-up. Although the BRS outweighs dyspnea severity in prediction of the endpoint, its prognostic role is strongest in mild-moderate dyspnea.
(Less)
- author
- Lund, Nathalie LU ; Gränsbo, Klas LU ; Wernersson, Camilla and Melander, Olle LU
- organization
- publishing date
- 2016-12-22
- type
- Contribution to journal
- publication status
- published
- subject
- in
- American Journal of Emergency Medicine
- volume
- 35
- issue
- 4
- pages
- 610 - 614
- publisher
- Elsevier
- external identifiers
-
- pmid:28062207
- scopus:85008474593
- wos:000398933300018
- ISSN
- 1532-8171
- DOI
- 10.1016/j.ajem.2016.12.048
- language
- English
- LU publication?
- yes
- id
- 3de45d0a-d454-4d7a-919a-f488def47a65
- date added to LUP
- 2017-01-12 13:19:51
- date last changed
- 2024-08-24 04:55:19
@article{3de45d0a-d454-4d7a-919a-f488def47a65, abstract = {{<p>BACKGROUND: Acute dyspnea affects a large heterogeneous patient group with high mortality and readmission rates.</p><p>PURPOSE: To investigate if cardiometabolic biomarkers and clinical characteristics predict readmission and death in patients hospitalized for acute dyspnea.</p><p>METHODS: 65 dyspnea patients at a general internal medicine ward were followed for six months. The combined endpoint was readmission or death.</p><p>MEASUREMENTS AND RESULTS: Cardiometabolic biomarkers at admission were related to the endpoint in Cox proportional hazard models (adjusted for sex, age, oxygen saturation, respiratory rate and C-reactive protein (CRP)). The biomarkers tissue-type plasminogen activator (tPA), prolactin (PRL), tumor necrosis factor receptor superfamily member 6 (FAS) and C-C motif chemokine 3 (CCL3) were independently and significantly related to the endpoint and combined into a biomarker risk score (BRS). Each SD increment of the BRS conferred a hazard ratio (HR) of 2.13 (1.39-3.27) P=0.001. The top vs bottom tertile of the BRS conferred a HR of 4.75 (1.93-11.68) P=0.001. Dyspnea severity was also associated with worse outcome, HR=3.43 (1.28-9.20) P=0.014. However, when mutually adjusted the BRS remained significant (P=0.004) whereas dyspnea severity was not. The BRS was related to the endpoint among patients with mild to moderate dyspnea (P=0.016) but not among those with severe dyspnea.</p><p>CONCLUSION: A score of tPA, PRL, FAS and CCL3 predicts 6-month death and readmission in patients hospitalized for acute dyspnea and may prove useful to optimize length of stay and follow-up. Although the BRS outweighs dyspnea severity in prediction of the endpoint, its prognostic role is strongest in mild-moderate dyspnea.</p>}}, author = {{Lund, Nathalie and Gränsbo, Klas and Wernersson, Camilla and Melander, Olle}}, issn = {{1532-8171}}, language = {{eng}}, month = {{12}}, number = {{4}}, pages = {{610--614}}, publisher = {{Elsevier}}, series = {{American Journal of Emergency Medicine}}, title = {{Cardiometabolic biomarkers are predictors of readmission and death in patients hospitalized for acute dyspnea}}, url = {{http://dx.doi.org/10.1016/j.ajem.2016.12.048}}, doi = {{10.1016/j.ajem.2016.12.048}}, volume = {{35}}, year = {{2016}}, }