Multimarker Strategy for Short-Term Risk Assessment in Patients With Dyspnea in the Emergency Department The MARKED (Multi mARKer Emergency Dyspnea)-Risk Score

Luc W. Eurlings, Sandra Sanders-van Wijk, Roland van Kimmenade, Aart Osinski, Lidwien van Helmond, Maud Vallinga, Harry J. Crijns, Marja P. van Dieijen-Visser, Hans-Peter Brunner-La Rocca, Yigal M. Pinto

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Abstract

Objectives The study aim was to determine the prognostic value of a multimarker strategy for risk-assessment in patients presenting to the emergency department (ED) with dyspnea. Background Combining biomarkers with different pathophysiological backgrounds may improve risk stratification in dyspneic patients in the ED. Methods The study prospectively investigated the prognostic value of the biomarkers N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), Cystatin-C (Cys-C), high-sensitivity C-reactive protein (hs-CRP), and Galectin-3 (Gal-3) for 90-day mortality in 603 patients presenting to the ED with dyspnea as primary complaint. Results hs-CRP, hs-cTnT, Cyst-C, and NT-proBNP were independent predictors of 90-day mortality. The number of elevated biomarkers was highly associated with outcome (odds ratio: 2.94 per biomarker, 95% confidence interval [CI]: 2.29 to 3.78, p <0.001). A multimarker approach had incremental value beyond a single-marker approach. Our multimarker emergency dyspnea-risk score (MARKED-risk score) incorporating age >= 75 years, systolic blood pressure <110 mm Hg, history of heart failure, dyspnea New York Heart Association functional class IV, hs-cTnT >= 0.04 mu g/l, hs-CRP >= 25 mg/l, and Cys-C >= 1.125 mg/l had excellent prognostic performance (area under the curve: 0.85, 95% CI: 0.81 to 0.89), was robust in internal validation analyses and could identify patients with very low ( <3 points), intermediate (>= 3, <5 points), and high risk ( <5 points) of 90-day mortality (2%, 14%, and 44% respectively; p <0.001). Conclusions A multimarker strategy provided superior risk stratification beyond any single-marker approach. The MARKED-risk score that incorporates hs-cTnT, hs-CRP, and Cys-C along with clinical risk factors accurately identifies patients with very low, intermediate, and high risk. (J Am Coll Cardiol 2012;60:1668-77) (c) 2012 by the American College of Cardiology Foundation
Original languageEnglish
Pages (from-to)1668-1677
JournalJournal of the American College of Cardiology
Volume60
Issue number17
DOIs
Publication statusPublished - 2012

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