title: Procalcitonin improves the Glasgow Prognostic Score for outcome prediction in emergency patients with cancer: a cohort study.
abstract: The Glasgow Prognostic Score (GPS) is useful for predicting long-term mortality in cancer patients. Our aim was to validate the GPS in ED patients with different cancer-related urgency and investigate whether biomarkers would improve its accuracy. We followed consecutive medical patients presenting with a cancer-related medical urgency to a tertiary care hospital in Switzerland. Upon admission, we measured procalcitonin (PCT), white blood cell count, urea, 25-hydroxyvitamin D, corrected calcium, C-reactive protein, and albumin and calculated the GPS. Of 341 included patients (median age 68 years, 61% males), 81 (23.8%) died within 30 days after admission. The GPS showed moderate prognostic accuracy (AUC 0.67) for mortality. Among the different biomarkers, PCT provided the highest prognostic accuracy (odds ratio 1.6 (95% confidence interval 1.3 to 1.9), P < 0.001, AUC 0.69) and significantly improved the GPS to a combined AUC of 0.74 (P = 0.007). Considering all investigated biomarkers, the AUC increased to 0.76 (P < 0.001). The GPS performance was significantly improved by the addition of PCT and other biomarkers for risk stratification in ED cancer patients. The benefit of early risk stratification by the GPS in combination with biomarkers from different pathways should be investigated in further interventional trials.
authors: Medical University Department of the University of Basel, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Anna Christina
authors: AC
authors: Rast
authors: Medical University Department of the University of Basel, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Alexander
authors: A
authors: Kutz
authors: Medical University Department of the University of Basel, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Susan
authors: S
authors: Felder
authors: Medical University Department of the University of Basel, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Institute of Psychology, University of Bern, Muesmatt, 3012 Bern, Switzerland.
authors: Lukas
authors: L
authors: Faessler
authors: Medical University Department of the University of Basel, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Deborah
authors: D
authors: Steiner
authors: Medical University Department of the University of Basel, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Svenja
authors: S
authors: Laukemann
authors: University Clinic of Infectious Diseases, University Hospital Bern, Freiburgstrasse 3, 3010 Bern, Switzerland.
authors: Sebastian
authors: S
authors: Haubitz
authors: Department of Laboratory Medicine, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Andreas
authors: A
authors: Huber
authors: Emergency Department, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Ulrich
authors: U
authors: Buergi
authors: Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Antoinette
authors: A
authors: Conca
authors: Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Barbara
authors: B
authors: Reutlinger
authors: Medical University Department of the University of Basel, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Beat
authors: B
authors: Mueller
authors: Division of Hematology & Oncology, Medical University Department of the University of Basel, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Mario
authors: M
authors: Bargetzi
authors: Medical University Department of the University of Basel, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
authors: Philipp
authors: P
authors: Schuetz
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002118:Calcium / Q000097:blood; D015331:Cohort Studies; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000473:pathology; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012709:Serum Albumin / Q000378:metabolism; D014508:Urea / Q000097:blood; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D014408:Biomarkers, Tumor; C000606589:CALCA protein, human; D011498:Protein Precursors; D012709:Serum Albumin; D014807:Vitamin D; D014508:Urea; D002116:Calcitonin; D002097:C-Reactive Protein; C104450:25-hydroxyvitamin D; D015740:Calcitonin Gene-Related Peptide; D002118:Calcium