Terhalle Lukas, Arntz Laura, Hoffmann Felix, Arnold Isabelle, Hafner Livia, Picking-Pitasch Laurentia, Zuppinger Joanna, Delport Lehnen Karen, Leuppi Jörg, Somasundaram Rajan, Nickel Christian H, Bingisser Roland
Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland.
Emergency Department, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Intern Emerg Med. 2025 Mar;20(2):585-595. doi: 10.1007/s11739-024-03693-6. Epub 2024 Jul 3.
Older patients presenting to the emergency department (ED) after falling are increasingly prevalent. Falls are associated with functional decline and death. Biomarkers predicting short-term mortality might facilitate decisions regarding resource allocation and disposition. D-dimer levels are used to rule out thromboembolic disease, while copeptin and adrenomedullin (MR-proADM) may be used as measures of the patient`s stress level. These nonspecific biomarkers were selected as potential predictors for mortality.
Prospective, international, multicenter, cross-sectional observation was performed in two tertiary and two regional hospitals in Germany and Switzerland. Patients aged 65 years or older presenting to the ED after a fall were enrolled. Demographic data, Activities of Daily Living (ADL), and D-dimers were collected upon presentation. Copeptin and MR-proADM levels were determined from frozen samples. Primary outcome was 30-day mortality; and secondary outcomes were mortality at 90, 180, and 365 days.
Five hundred and seventy-two patients were included. Median age was 83 [IQR 78, 89] years, 236 (67.7%) were female. Mortality overall was 3.1% (30 d), 5.4% (90 d), 7.5% (180 d), and 13.8% (365 d), respectively. Non-survivors were older, had a lower ADL index and higher levels of all three biomarkers. Elevated levels of MR-proADM and D-dimer were associated with higher risk of mortality. MR-proADM and D-dimer showed high sensitivity and low negative likelihood ratio regarding short-term mortality, whereas copeptin did not.
D-dimer and MR-proADM levels might be useful as prognostic markers in older patients presenting to the ED after a fall, by identifying patients at low risk of short-term mortality.
ClinicalTrials.gov Identifier: NCT02244983.
跌倒后前往急诊科（ED）就诊的老年患者日益增多。跌倒与功能衰退和死亡相关。预测短期死亡率的生物标志物可能有助于做出资源分配和处置的决策。D-二聚体水平用于排除血栓栓塞性疾病，而 copeptin 和肾上腺髓质素（MR-proADM）可作为患者应激水平的指标。这些非特异性生物标志物被选为潜在的死亡率预测指标。
在德国和瑞士的两家三级医院和两家地区医院进行了前瞻性、国际性、多中心横断面观察。纳入年龄在65岁及以上、跌倒后前往急诊科就诊的患者。就诊时收集人口统计学数据、日常生活活动能力（ADL）和D-二聚体。从冷冻样本中测定copeptin和MR-proADM水平。主要结局为30天死亡率；次要结局为90天、180天和365天死亡率。
共纳入572例患者。中位年龄为83岁[四分位间距78，89]，236例（67.7%）为女性。总体死亡率分别为3.1%（30天）、5.4%（90天）、7.5%（180天）和13.8%（365天）。非幸存者年龄更大，ADL指数更低，所有三种生物标志物水平更高。MR-proADM和D-二聚体水平升高与更高死亡率风险相关。MR-proADM和D-二聚体对短期死亡率显示出高敏感性和低阴性似然比，而copeptin则未显示。
D-二聚体和MR-proADM水平可能有助于识别跌倒后前往急诊科就诊的老年患者中短期死亡风险低的患者，作为预后标志物。
ClinicalTrials.gov标识符：NCT02244983。
