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Adrenomedullin for Risk Stratification of Emergency Patients With Nonspecific Complaints: An Interventional
Christian Hans Nickel1, Anna Sarah Messmer, Leyla Ghanim
1From the Emergency Department, University Hospital, Basel (CHN, ASM, LG, JI-K, RB); Emergency Department, Kantonsspital Baselland, Liestal, Switzerland (NG); Research Department, Thermo Scientific Biomarkers, Hennigsdorf, Germany (SG, SH); and Emergency Department, Kantonsspital Olten, Olten, Switzerland (SE).
Medicine
|January 7, 2016
Summary
Biomarker-assisted decision-making using midregional pro-adrenomedullin (MR-proADM) is safe for emergency department patients with nonspecific complaints. This approach did not increase mortality or discharge rates, demonstrating potential for improved patient care.
Area of Science:
- Emergency Medicine
- Clinical Biomarkers
- Medical Decision-Making
Background:
- Patients with nonspecific complaints in the emergency department (ED) face risks of serious conditions.
- Midregional portion of adrenomedullin (MR-proADM) is a novel stress biomarker with potential to aid clinical decisions.
Purpose of the Study:
- To evaluate if biomarker-assisted patient disposition in the ED impacts mortality.
- To determine if combining MR-proADM levels with clinical assessment affects discharge rates and appropriateness of care.
- To assess the feasibility of implementing a biomarker-assisted algorithm in the ED setting.
Main Methods:
- A prospective, multicenter, randomized controlled trial involving 398 patients with nonspecific complaints.
- Patients were randomized to standard care (clinical assessment only) or biomarker-assisted care (clinical assessment + MR-proADM levels).
- Disposition was categorized into high-risk (hospital admission), intermediate-risk (geriatric hospital), and low-risk (discharge) based on assessment.
Main Results:
- The 30-day mortality rate was 4.3% in the biomarker-assisted group versus 6.2% in the standard care group (not statistically significant).
- No significant differences were observed in secondary endpoints, including ED and hospital length of stay, and readmission rates.
- Feasibility was partially demonstrated, with a high rate of overruling the proposed algorithm (51 cases).
Conclusions:
- Biomarker-assisted disposition using MR-proADM is safe for patients with nonspecific complaints in the ED.
- The study did not show an increase in discharge rates or a decrease in inappropriate lower-level care disposition.
- Further research is needed to address the high overruling rate and optimize the feasibility of this approach in clinical practice.
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