title: Asymmetric dimethylarginine predicts outcome and time of stay in hospital in patients attending an internal medicine emergency room.
abstract: 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.
authors.affiliation: University Hospital Hamburg-Eppendorf, Institute for Experimental and Clinical Pharmacology and Toxicology, Hamburg, Germany. fschulze@uke.uni-hamburg.de
authors.forename: Friedrich
authors.initials: F
authors.lastname: Schulze
authors.forename: Jörn
authors.initials: J
authors.lastname: Vollert
authors.forename: Renke
authors.initials: R
authors.lastname: Maas
authors.forename: Reinhold
authors.initials: R
authors.lastname: Müller
authors.forename: Edzard
authors.initials: E
authors.lastname: Schwedhelm
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.forename: Rainer H
authors.initials: RH
authors.lastname: Böger
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
mesh_terms: 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
chemical_list: C018524:N,N-dimethylarginine; D001120:Arginine