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Cardiometabolic biomarkers are predictors of readmission and death in patients hospitalized for acute dyspnea

Lund, Nathalie LU ; Gränsbo, Klas LU ; Wernersson, Camilla and Melander, Olle LU (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.

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author
organization
publishing date
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
  • 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
2017-11-13 08:35:25
@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},
  volume       = {35},
  year         = {2016},
}