Nonspecific stress biomarkers for mortality prediction in older emergency department patients presenting with falls: a prospective multicenter observational study - Terhalle, L.; Arntz, L.; Hoffmann, F.; Arnold, I.; Hafner, L.; Picking-Pitasch, L.; Zuppinger, J.; Delport Lehnen, K.; Leuppi, J.; Somasundaram, R.; Nickel, C. H.; Bingisser, R. (Intern Emerg Med, 2024)
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.
Keywords: journalArticle; *Accidental Falls/mortality/statistics & numerical data; *Biomarkers/blood/analysis; *Mortality/trends; Adrenomedullin; Adrenomedullin/blood/analysis; Aged; Aged, 80 and over; Biomarkers; Copeptin; Cross-Sectional Studies; D-dimer; Emergency Service, Hospital/organization & administration/statistics & numerical; Emergency department; Female; Fibrin Fibrinogen Degradation Products/analysis; Germany; Glycopeptides/blood/analysis; Humans; Male; Mortality prediction; Patients, aged 65 years and older, who presented to the ED within 24 h after a; Peptide Fragments/blood/analysis; Prospective Studies; Switzerland; according to the principles of the Declaration of Helsinki. Informed consent:; data; disclose. Ethical approval, Human and animal rights: This study was approved by; fall and provided informed consent, were enrolled in the study; the local ethics committee (identifier 2014-184, ww.eknz.ch) and conducted