Prognostic value of different biomarkers for cardiovascular death in unselected older patients in the emergency department

Bahrmann, Philipp; Christ, Michael; Hofner, Benjamin; Bahrmann, Anke; Achenbach, Susanne; Sieber, Cornel; Bertsch, Thomas

doi:10.1177/2048872615612455

Cited by 17 publications

(11 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast to previous examinations, diagnostic sensitivity in our trial (40 %) is moderate as compared to previous reports (70 -92 %) [7,8]. It is tempting to speculate that this may be due to the method of final adjudication of AHF diagnosis in respective trials: Final adjudicated diagnosis of AHF in our trial was done by 2 experienced physicians (cardiologist, emergency physician) using all available patient data for adjudication [1,10], while other reports used scores including descriptive methods of pulmonary congestions and/or cardiac decompensation for final diagnosis questioning accuracy of final adjudicated diagnosis [6,8]. Of note, some of the enrolled patients were pre-treated by EMS based emergency physicians before being admitted to ED.…”

contrasting

confidence: 69%

Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure

Glöckner

Christ

Geier

et al. 2016

Ultrasound International Open

View full text Add to dashboard Cite

Aim: The objective of this pilot study was to determine the accuracy of point-of-care B-line lung ultrasound in comparison to NT Pro-BNP for screening acute heart failure. Materials and Methods: An 8-zone lung ultrasound was performed by experienced sonographers in patients presenting with acute dyspnea in the ED. AHF was determined as the final diagnosis by 2 independent reviewers. Results: Contrary to prior studies, B-line ultrasound in our study was highly specific, but moderately sensitive for identifying patients with AHF. There was a strong association between elevated NT-proBNP levels and an increased number of B-lines. Conclusion: In conclusion, point-of-care lung ultrasound is a helpful tool for ruling in or ruling out important differential diagnoses in ED patients with acute dyspnea.

show abstract

contrasting

confidence: 69%

Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure

Glöckner

Christ

Geier

et al. 2016

Ultrasound International Open

View full text Add to dashboard Cite

show abstract

“…Final adjudicated diagnosis of AHF was determined by two experienced physicians (cardiologist, emergency physician) using all available patient data for adjudication [ 1 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Lung Ultrasound Eight-Point Method in Diagnosing Acute Heart Failure in Emergency Patients with Acute Dyspnea: Diagnostic Accuracy and 72 h Monitoring

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background and Objectives: Acute dyspnea is a common chief complaint in the emergency department (ED), with acute heart failure (AHF) as a frequent underlying disease. Early diagnosis and rapid therapy are highly recommended by international guidelines. This study evaluates the accuracy of point-of-care B-line lung ultrasound in diagnosing AHF and monitoring the therapeutic success of heart failure patients. Materials and Methods: This is a prospective mono-center study in adult patients presenting with undifferentiated acute dyspnea to a German ED. An eight-zone pulmonary ultrasound was performed by experienced sonographers in the ED and 24 and 72 h after. Along with the lung ultrasound evaluation patients were asked to assess the severity of shortness of breath on a numeric rating scale. The treating ED physicians were asked to assess the probability of AHF as the underlying cause. Final diagnosis was adjudicated by two independent experts. Follow-up was done after 30 and 180 days. Results: In total, 102 patients were enrolled. Of them, 89 patients received lung ultrasound evaluation in the ED. The sensitivity of lung ultrasound evaluation in ED in diagnosing AHF was 54.2%, specificity 97.6%. As much as 96.3% of patients with a positive LUS test result for AHF in ED actually suffered from AHF. Excluding diuretically pretreated patients, sensitivity of LUS increased to 75% in ED. Differences in the sum of B-lines between admission time point, 24 and 72 h were not statistically significant. There were no statistically significant differences in the subjectively assessed severity of dyspnea between AHF patients and those with other causes of dyspnea. Of the 89 patients, 48 patients received the final adjudicated diagnosis of AHF. ED physicians assessed the probability of AHF in patients with a final diagnosis of AHF as 70%. Roughly a quarter (23.9%) of the overall cohort patients were rehospitalized within 30 days after admission, 38.6% within 180 days of follow-up. Conclusion: In conclusion, point-of-care lung ultrasound is a helpful tool for the early rule-in of acute heart failure in ED but only partially suitable for exclusion. Of note, the present study shows no significant changes in the number of B-lines after 24 and 72 h.

show abstract

“…We focused on liver, cardiac and renal dysfunction/injury using arbitrary definitions, mainly due to the lack of well‐validated biomarkers to quantify dysfunction, injury, or failure of the other organs . Regarding the definitions, we applied an approach widely used in previous studies . In the context of liver dysfunction/injury, it may be perceived as somehow non‐specific, as we also considered low albumin level in the definition.…”

Section: Discussionmentioning

confidence: 99%

Multi‐organ dysfunction/injury on admission identifies acute heart failure patients at high risk of poor outcome

Zymliński

Sokolski

Biegus

et al. 2018

European J of Heart Fail

View full text Add to dashboard Cite

Background Clinical consequences of an interplay between dysfunction/injury of different end‐organs in acute heart failure (AHF) remain unknown. Methods and results In 284 consecutive AHF patients, end‐organ dysfunction/injury was defined as cardiac [troponin I level above the upper reference limit (URL, > 0.056 ng/mL)], kidney (estimated glomerular filtration rate < 60 mL/min/1.73 m2), and liver [at least one of the following: aspartate transaminase (AST)/alanine transaminase (ALT) > 3 times the URL (> 114 IU/L and > 105 IU/L for AST and ALT, respectively), bilirubin above the URL (> 1.3 mg/mL), albumin below the lower reference limit (< 3.5 mg/dL)]. The primary endpoints were early (within first 48 h) in‐hospital worsening of heart failure and 1‐year all‐cause mortality. On admission, cardiac, kidney, liver dysfunction/injury were present in 38%, 50%, and 54% of patients, respectively. Patients were classified as having 0, 1, 2, or 3 organ injury/dysfunction (17%, 36%, 35%, and 12% of patients, respectively). Baseline clinical characteristics and co‐morbidity profile were similar across groups. Patients with three organ dysfunction/injury had the worst 1‐year survival rate [46%; hazard ratio (HR) with 95% confidence interval (CI) vs. patients without organ dysfunction: 6.75 (2.52–18.13), those with two (67%; HR 3.54, 95% CI 1.38–9.08), one (84%; HR 1.58, 95% CI 0.58–4.30), or no organ dysfunction/injury (90%); P < 0.01]. Worsening of heart failure was more frequent in patients with three and two vs. those with one or no organ dysfunction/injury (37% vs. 38% vs. 23% vs. 21%, P < 0.05). Conclusions In patients with AHF, dysfunction/injury of > 1 end‐organ dysfunction/injury identifies patients at the highest risk of poor outcomes.

show abstract

Prognostic value of different biomarkers for cardiovascular death in unselected older patients in the emergency department

Cited by 17 publications

References 34 publications

Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure

Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure

Lung Ultrasound Eight-Point Method in Diagnosing Acute Heart Failure in Emergency Patients with Acute Dyspnea: Diagnostic Accuracy and 72 h Monitoring

Multi‐organ dysfunction/injury on admission identifies acute heart failure patients at high risk of poor outcome

Contact Info

Product

Resources

About