title: Independent predictors of major adverse cardiovascular events in emergency department patients who are hospitalised with a suspected infection: a retrospective cohort study.
abstract: OBJECTIVE
  Emergency department (ED) patients hospitalised with a suspected infection have an increased risk for major adverse cardiovascular events (MACE). This study aims to identify independent predictors of MACE after hospital admission which could be used for identification of high-risk patients who may benefit from preventive strategies.
  
  
  METHODS
  Dutch tertiary care centre and urban hospital.
  
  
  METHODS
  Consecutive, hospitalised, ED patients with a suspected infection.
  
  
  METHODS
  This was a secondary analysis using an existing database in which consecutive, hospitalised, ED patients with a suspected infection were prospectively enrolled. Potential independent predictors, including illness severity, as assessed by the Predisposition, Infection, Response, Organ failure (PIRO) score, and classic cardiac risk factors were analysed by multivariable binary logistic regression. Prognostic and discriminative performance of the model was quantified by the Hosmer-Lemeshow test and receiver operator characteristics with area under the curve (AUC) analyses, respectively. Maximum sensitivity and specificity for identification of MACE were calculated.
  
  
  METHODS
  MACE within 90 days after hospital admission.
  
  
  RESULTS
  36 (2.1%) of the 1728 included patients developed MACE <90 days after ED presentation. Independent predictors of MACE were the RO components of the PIRO score, reflecting acute organ failure, with a corrected OR (OR (95% CI) 1.1 (1.0 to 1.3) per point increase), presence of atrial fibrillation/flutter; OR 3.9 (2.0 to 7.7) and >2 classic cardiovascular risk factors; 2.2 (1.1 to 4.3). The AUC was 0.773, and the goodness-of-fit test had a p value of 0.714. These predictors identified MACE with 75% sensitivity and 70% specificity.
  
  
  CONCLUSIONS
  Besides the classical cardiovascular risk factors, atrial fibrillation and signs of acute organ failure were independent risk factors of MACE in ED patients hospitalised with a suspected infection. Future studies should investigate whether preventive measures like antiplatelet therapy should be initialised in hospitalised ED patients with suspected infection and high risk for MACE.
authors.affiliation: Emergency Department, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: de Groot
authors.affiliation: Emergency Department, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Stefanie
authors.initials: S
authors.lastname: van den Berg
authors.affiliation: Emergency Department, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Joanne
authors.initials: J
authors.lastname: Kessler
authors.affiliation: Emergency Department, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Ansems
authors.affiliation: Emergency Department, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Douwe
authors.initials: D
authors.lastname: Rijpsma
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000209:etiology*; D004636:Emergency Service, Hospital; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000150:complications* / Q000628:therapy; D009426:Netherlands; D063305:Organ Dysfunction Scores; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
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