Page 34 - Biomarkers for risk stratification and guidance in heart failure

Multimarker risk score in emergency department dyspnea
cause mortality by MARKED-risk score category and table 5 depicts secondary endpoint-rates per MARKED-risk score category. The mortality risk of non-
admitted versus admitted patients was similar within each risk score category
(low: 1% vs 2%, P=0.66, intermediate: 11% vs 15%, P=0.30, high: 39% vs 46%,
P=0.64). In addition, 9% of the patients that were discharged from the ED were in 2 the high-risk category and 39% of these patients died within 90 days, underscoring
the clinical prognostic uncertainty and the potential importance of the MARKED- risk score in this setting.
Added value of biomarkers on top of PRIDE mortality score
We evaluated the incremental value of the biomarkers Cys-C, hs-cTNT and hs- CRP with the PRIDE mortality score,6 which includes clinical risk factors and NT-proBNP. For 90-day mortality, the combination of the three biomarkers significantly improved the PRIDE mortality score as depicted by an increase in C-statistic from 0.75 (95% CI 0.69–0.80) to 0.85 (95% CI 0.81 – 0.89, P<0.001), a NRI of 33% (P<0.001) and an IDI of 14% (P<0.001). For 1-year mortality, the C-statistic of the PRIDE mortality score was 0.72 (95% CI 0.68 – 0.77), which improved to 0.79 (95% CI 0.74 – 0.83, P<0.001) by addition of hs-cTnT, hs-CRP and Cys-C.
Figure 3. 90-day mortality rate for MARKED-risk score
N=number of patients per group.
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