• Lukas Terhalle, Laura Arntz, Felix Hoffmann, Isabelle Arnold, Livia Hafner, Laurentia Picking-Pitasch, Joanna Zuppinger, Karen Delport Lehnen, Jörg Leuppi, Rajan Somasundaram, Christian H Nickel, and Roland Bingisser.
• Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland. lukas.terhalle@usb.ch.
• Intern Emerg Med. 2024 Jul 3.

BackgroundOlder 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.MethodsProspective, 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.ResultsFive 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.ConclusionD-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.Trial RegistrationClinicalTrials.gov Identifier: NCT02244983.© 2024. The Author(s).

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