Asymmetric dimethylarginine predicts outcome and time of stay in hospital in patients attending an internal medicine emergency room.
BACKGROUND
For patients attending the emergency room (ER) valid diagnostic criteria which identify patients at risk for an adverse outcome are needed. We investigated the predictive value of asymmetric dimethylarginine (ADMA) in unselected patients attending an internal medicine ER regarding outcome of the patients and duration of stay in the hospital.


METHODS
Patients (n=417) attending the ER were classified according to their primary diagnosis. Routine laboratory tests were performed and ADMA was determined. Patients were followed for a primary endpoint of in hospital death and complicated outcome.


RESULTS
ADMA levels were highest in patients with a cancer-related diagnosis (0.76 (0.63-0.93) micromol/L) and in patients with a cardiovascular diagnosis (0.69 (0.60-0.80) micromol/L; p<0.001). Overall, we found increasing proportions of patients experiencing the primary end point over the quartiles of ADMA (4.6%, 8.2%, 9.6%, and 15.8%; p=0.007). ADMA had the highest predictive value for the primary endpoint in patients with cardiovascular disease (odds ratio 19.4; p=0.029). In a Cox proportional hazard model ADMA was an independent predictor of the length of hospitalization (hazard ratio 2.0 (95% CI: 1.3-3.3); p=0.006) in the entire cohort.


CONCLUSIONS
We conclude that ADMA independently predicts future complications and hospitalization in patients attending an ER.
Schulze
Friedrich
F
University Hospital Hamburg-Eppendorf, Institute for Experimental and Clinical Pharmacology and Toxicology, Hamburg, Germany. fschulze@uke.uni-hamburg.de
Vollert
Jörn
J
Maas
Renke
R
Müller
Reinhold
R
Schwedhelm
Edzard
E
Müller
Christian
C
Böger
Rainer H
RH
Möckel
Martin
M
D000328:Adult; D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment
C018524:N,N-dimethylarginine; D001120:Arginine