title: Cardiometabolic biomarkers are predictors of readmission and death in patients hospitalized for acute dyspnea.
abstract: BACKGROUND
  Acute dyspnea affects a large heterogeneous patient group with high mortality and readmission rates.
  
  
  OBJECTIVE
  To investigate if cardiometabolic biomarkers and clinical characteristics predict readmission and death in patients hospitalized for acute dyspnea.
  
  
  METHODS
  65 dyspnea patients at a general internal medicine ward were followed for six months. The combined endpoint was readmission or death.
  
  
  RESULTS
  Cardiometabolic biomarkers at admission were related to the endpoint in Cox proportional hazard models (adjusted for sex, age, oxygen saturation, respiratory rate and C-reactive protein (CRP)). The biomarkers tissue-type plasminogen activator (tPA), prolactin (PRL), tumor necrosis factor receptor superfamily member 6 (FAS) and C-C motif chemokine 3 (CCL3) were independently and significantly related to the endpoint and combined into a biomarker risk score (BRS). Each SD increment of the BRS conferred a hazard ratio (HR) of 2.13 (1.39-3.27) P=0.001. The top vs bottom tertile of the BRS conferred a HR of 4.75 (1.93-11.68) P=0.001. Dyspnea severity was also associated with worse outcome, HR=3.43 (1.28-9.20) P=0.014. However, when mutually adjusted the BRS remained significant (P=0.004) whereas dyspnea severity was not. The BRS was related to the endpoint among patients with mild to moderate dyspnea (P=0.016) but not among those with severe dyspnea.
  
  
  CONCLUSIONS
  A score of tPA, PRL, FAS and CCL3 predicts 6-month death and readmission in patients hospitalized for acute dyspnea and may prove useful to optimize length of stay and follow-up. Although the BRS outweighs dyspnea severity in prediction of the endpoint, its prognostic role is strongest in mild-moderate dyspnea.
authors.affiliation: Skåne University Hospital Malmö, Clinical Research Centre, Malmoe, Sweden. Electronic address: nathalie.lund@med.lu.se.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lund
authors.affiliation: Skåne University Hospital Malmö, Clinical Research Centre CRC, Malmoe, Sweden.
authors.forename: Klas
authors.initials: K
authors.lastname: Gränsbo
authors.affiliation: Skåne University Hospital Malmö, Clinical Research Centre CRC, Malmoe, Sweden.
authors.forename: Camilla
authors.initials: C
authors.lastname: Wernersson
authors.affiliation: Skåne University Hospital Malmö, Clinical Research Centre CRC, Malmoe, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Melander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D054405:Chemokine CCL3 / Q000097:blood*; D004417:Dyspnea / Q000097:blood*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009026:Mortality; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D011388:Prolactin / Q000097:blood*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013548:Sweden; D010959:Tissue Plasminogen Activator / Q000097:blood*; D019014:fas Receptor / Q000097:blood*
chemical_list: D015415:Biomarkers; C515429:CCL3 protein, human; D054405:Chemokine CCL3; C491901:FAS protein, human; D019014:fas Receptor; D011388:Prolactin; D010959:Tissue Plasminogen Activator
keywords: Prognosis; acute dyspnea; biomarker; risk score