Endostatin predicts mortality in patients with acute dyspnea – A cohort study of patients seeking care in emergency departments

Carlsson, Axel C.; Wessman, Torgny; Larsson, Anders; Leijonberg, G; Tofik, Rafid; Ärnlöv, Johan; Melander, Olle; Ruge, Thoralph

doi:10.1016/j.clinbiochem.2019.10.004

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…A total of 1710 patients aged ≥18 years seeking the emergency department (ED) of Skåne University Hospital in Malmö on weekdays, 8 a.m. to 5 p.m., between December 2013 and July 2018 were enrolled in a study of acute dyspnoea (ADYS) described previously. 23 A research nurse approached patients triaged as dyspnoea and collected written informed consent, clinical parameters through structured questions and review of patient records, and blood samples through peripheral venipuncture. Skåne University Hospital in Malmö serves a catchment area of 400 000 subjects from Malmö, the third largest city in Sweden, and the ED has up to 85 000 visits per year.…”

Section: Methodsmentioning

confidence: 99%

“…Most patients with elevated mRAP also had elevated PAWP (n = 119), while pulmonary hypertension was present in 76% of the patients with mRAP >10 mmHg and a PAWP <15. Overall mPAP was mildly elevated (median 27 mmHg [IQR [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]). Most haemodynamic measures were at least modestly correlated (Supporting Information, Figure S3), with modest inverse correlations of both mRAP and PAWP with cardiac index (r = À0.3 and r = À0.4), SVI (r = À0.4 and r = À0.5), SvO 2 (r = À0.6 for both) and positive correlations with mPAP (r = 0.5 and r = 0.8) and RVPd (r = 0.7 and r = 0.5).…”

Section: Bioactive Adrenomedullin and Central Haemodynamicsmentioning

confidence: 99%

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Bioactive adrenomedullin for assessment of venous congestion in heart failure

et al. 2022

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Aims Bioactive adrenomedullin (bio-ADM) is a vascular-derived peptide hormone that has emerged as a promising biomarker for assessment of congestion in decompensated heart failure (HF). We aimed to evaluate diagnostic and prognostic performance of bio-ADM for HF in comparison to amino-terminal pro-B-type natriuretic peptide (NT-proBNP), with decision thresholds derived from invasive haemodynamic and population-based studies. Methods and resultsNormal reference ranges for bio-ADM were derived from a community-based cohort (n = 5060). Correlations with haemodynamic data were explored in a cohort of HF patients undergoing right heart catheterization (n = 346). Mortality and decision cutoffs for bio-ADM was explored in a cohort of patients presenting in the ER with acute dyspnoea (n = 1534), including patients with decompensated HF (n = 570). The normal reference range was 8-39 pg/mL. The area under the receiver operating characteristic curve (AUROC) for discrimination of elevated mean right atrial pressure (mRAP) and pulmonary arterial wedge pressure (PAWP) was 0.74 (95% CI = 0.67-0.79) and 0.70 (95% CI = 0.64-0.75), respectively, with optimal bio-ADM decision cutoff of 39 pg/mL, concordant with cubic spline analyses. NT-proBNP discriminated PAWP slightly better than mRAP (AUROC 0.73 [95% CI = 0.68-0.79] and 0.68 [95% CI = 0.61-0.75]). Bio-ADM correlated with (mRAP, r = 0.55) while NT-proBNP correlated with PAWP. Finally, a bio-ADM decision cutoff of 39 pg/mL associated with 30 and 90 day mortality and conferred a two-fold increased odds of HF diagnosis, independently from NT-proBNP. Conclusions Bio-ADM tracks with mRAP and associates with measures of systemic congestion and with mortality in decompensated HF independently from NT-proBNP. Our findings support utility of bio-ADM as a biomarker of systemic venous congestion in HF and nominate a decision threshold.

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Section: Methodsmentioning

confidence: 99%

Section: Bioactive Adrenomedullin and Central Haemodynamicsmentioning

confidence: 99%

Bioactive adrenomedullin for assessment of venous congestion in heart failure

et al. 2022

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“…Elevated plasma endostatin levels in humans are reported to be involved in the pathogenesis of tumors, chronic inflammatory conditions, atherosclerosis, chronic kidney failure and cardiovascular injury [ 11–13 ]. Additionally, endostatin was reported to be associated with adverse outcome and morality in patients presenting at the emergency department with acute dyspnoea [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Plasma Endostatin Correlates with Hypoxia and Mortality in Covid-19-Associated Acute Respiratory Failure

et al. 2021

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Background: The contribution of endothelial injury in the pathogenesis of COVID-19-associated acute respiratory distress syndrome (ARDS) and resulting respiratory failure remains unclear. Plasma endostatin, an endogenous inhibitor of angiogenesis and endothelial dysfunction is upregulated during hypoxia, inflammation and progress of pulmonary disease. Aim: To investigate if plasma endostatin is associated to hypoxia, inflammation and 30-day mortality in patients with severe COVID-19 infection. Method: Samples for blood analysis and plasma endostatin quantification were collected from adult patients with ongoing COVID-19 (n = 109) on admission to intensive care unit (day 1). Demographic characteristics and 30-day mortality data were extracted from medical records. The ability of endostatin to predict mortality was analyzed using receiving operating characteristics and Kaplan–Meier analysis with a cutoff at 46.2 ng/ml was used to analyze the association to survival. Results: Plasma endostatin levels correlated with; PaO2/FiO2 (r = -0.3, p < 0.001), arterial oxygen tension (r = -0.2, p = 0.01), lactate (r = 0.2, p = 0.04), C-reactive protein (r = 0.2, p = 0.04), ferritin (r = 0.2, p = 0.09), D-dimer (r = 0.2, p = 0.08) and IL-6 (r = 0.4, p < 0.001). Nonsurvivors at 30 days had higher plasma endostatin levels than survivors (72 ± 26 vs 56 ± 16 ng/ml, p = 0.01). Receiving operating characteristic curve (area under the curve 0.7) showed that plasma endostatin >46.2 ng/ml predicts mortality with a sensitivity of 92% and specificity of 71%. In patients with plasma endostatin >46.2 ng/ml probability of survival was lower (p = 0.02) in comparison to those with endostatin <46.2 ng/ml. Conclusion: Our results suggest that plasma endostatin is an early biomarker for disease severity in COVID-19.

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“…The aim of this study was to determine the effect of BMI on short- and long-term mortality rates in elderly acute ill patients, with or without diabetes, admitted to the emergency department (ED). As a model, we chose a cohort of patients admitted to the ED because of acute dyspnoea, the ‘Acute Dyspnea Study’ (ADYS) ( 18 ), known to include severely ill patients with a high level of comorbidity.…”

Section: Introductionmentioning

confidence: 99%

The association between BMI and 90-day mortality in patients with and without diabetes seeking care at the emergency department

Wändell

Carlsson

Larsson

et al. 2021

ujms

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Background: The impact of body mass index (BMI) on mortality varies with age and disease states. The aim of this research study was to analyse the associations between BMI categories and short- and long-term mortality in patients with or without diabetes seeking care at the emergency department (ED) with acute dyspnoea. Population and methods: Patients aged ≥18 years at ED during daytime on weekdays from March 2013 to July 2018 were included. Participants were triaged according to the Medical Emergency Triage and Treatment System-Adult score (METTS-A), and blood samples were collected. Totally, 1,710 patients were enrolled, with missing values in 113, leaving 1,597 patients, 291 with diabetes and 1,306 without diabetes. The association between BMI and short-term (90-day) and long-term (mean follow-up time 2.1 years) mortality was estimated by Cox regression with normal BMI (18.5–24.9) as referent category, with adjustment for age, sex, METTS-A scoring, glomerular filtration rate, smoking habits and cardiovascular comorbidity in a fully adjusted model. The Bonferroni correction was also used. Results: Regarding long-term mortality, patients with diabetes and BMI category ≥30 kg/m2 had a fully adjusted Hazard Ratio (HR) of 0.40 (95% confidence interval [CI]: 0.23–0.69), significant after the Bonferroni correction. Amongst patients without diabetes, those with underweight had an increased risk but only of borderline significance, whilst risks in those with overweight or obesity did not differ from reference. Regarding short-term mortality, risks did not differ from reference amongst patients with or without diabetes. Conclusions: We found divergent long-term mortality risks in patients with and without diabetes, with lower risk in obese patients (BMI ≥ 30 kg/m2) with diabetes, but no increased risk for patients without diabetes and overweight (BMI: 25–29.9 kg/m2) and obesity.

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Endostatin predicts mortality in patients with acute dyspnea – A cohort study of patients seeking care in emergency departments

Cited by 4 publications

References 28 publications

Bioactive adrenomedullin for assessment of venous congestion in heart failure

Bioactive adrenomedullin for assessment of venous congestion in heart failure

Plasma Endostatin Correlates with Hypoxia and Mortality in Covid-19-Associated Acute Respiratory Failure

The association between BMI and 90-day mortality in patients with and without diabetes seeking care at the emergency department

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