@article{ref1,
title="Nonspecific stress biomarkers for mortality prediction in older emergency department patients presenting with falls: a prospective multicenter observational study",
journal="Internal and emergency medicine",
year="2024",
author="Terhalle, Lukas and Arntz, Laura and Hoffmann, Felix and Arnold, Isabelle and Hafner, Livia and Picking-Pitasch, Laurentia and Zuppinger, Joanna and Delport Lehnen, Karen and Leuppi, Jörg and Somasundaram, Rajan and Nickel, Christian H. and Bingisser, Roland",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="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. <br><br>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. <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="1828-0447",
doi="10.1007/s11739-024-03693-6",
url="http://dx.doi.org/10.1007/s11739-024-03693-6"
}