Prognostic value of different biomarkers for cardiovascular death in unselected older patients in the emergency department
Prognostic value of different biomarkers for cardiovascular death in unselected older patients in the emergency department
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DOI：
10.1177/2048872615612455
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发表时间：
2016-12-01
影响因子：
4.1
通讯作者：
Bertsch, Thomas
中科院分区：
文献类型：
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作者：
Bahrmann, Philipp;Christ, Michael;Bertsch, Thomas
背景：对急诊科（艾德）就诊的心力衰竭（HF）老年患者进行风险分层是一个尚未解决的挑战。我们前瞻性地研究了不同的生物标志物在老年患者的预后表现在艾德。方法：我们连续招募了302名非手术患者70年提出的艾德与广泛的心血管和非心血管共病条件。入院时测定N端B型利钠肽前体（NT-proBNP）、中段肾上腺髓质素前体（MR-proADM）、中段心房利钠肽前体（MR-proANP）、C端内皮素前体（CT-proET-1）、超敏C端精氨酸加压素前体（Copeptin-us）和高敏心肌肌钙蛋白T（hs-cTnT）。在使用循环NT-proBNP水平审查所有可用基线数据后，由两名心脏病专家独立裁定HF的最终诊断。302例患者中有120例（40%）最终诊断为HF。所有患者在随后的12个月内随访心血管死亡。为了测试所研究的生物标志物的预后性能，我们使用以年龄和性别作为强制协变量的加强模型。Boosting是一种内置变量选择的统计学习技术，用于获得稀疏和可解释的预测模型。在中位随访时间225天（四分位距（IQR）156-319天）期间，302例患者（年龄816岁）中有30例（9.9%）发生心血管死亡。在这30名患者中，21名患有心力衰竭，9名在入院前未诊断出心力衰竭。加强模型选择MR-proADM和hs-cTNT作为心血管死亡的预测因子。随访期间，心血管死亡患者的MR-proADM和hs-cTnT中位值显著高于存活患者（2.56 nmol/L（IQR 1.62-4.48）vs. 1.11 nmol/L（IQR 0.83-1.80），P
Background: 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.Methods: 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.Results: 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 816 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