Page 39 - Biomarkers for risk stratification and guidance in heart failure

Chapter 2
of dyspnea indicated by New York Heart Association functional class in our cohort was comparable to previous cohorts, although the percentage of patients diagnosed with acute HF as well as the 90-day and 1-year mortality rates were somewhat higher in our cohort6, 51, 52.
Limitations
First our study was performed in a single center ED. In addition, we did not externally validate the MARKED-risk score. However, results were robust in 2 internal validation analyses (cross-validation and bootstrapping) which are known to result in stable and nearly unbiased estimates of performance 23, 53 and our study is comparable to other dyspnea-cohorts as discussed. Second, the number of patients was of moderate size. Taking this together, it will be of interest to validate our findings in a separate, preferably larger cohort. Finally, our study is not able to directly assess the impact of the MARKED-risk score on the management of patients. Therefore, the therapeutic consequence of using the MARKED-risk score in clinical practice for stratifying patients with dyspnea needs prospective evaluation.
Conclusions
We present a simple, straightforward, non-diagnosis-specific multi marker score for short-term risk stratification in patients with dyspnea presenting to the ED, a population with large diagnostic and prognostic uncertainty. This multi-marker approach that incorporates hs-cTnT, hs-CRP and Cys-C along with clinical risk factors (age≥75 years, dyspnea at rest, history of heart failure, and systolic blood pressure <110mmHg) has incremental value beyond a single-marker approach. Moreover, the MARKED risk score is able to accurately identify patients with very low, intermediate and especially those with excessive high risk and may be useful in clinical practice.
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