• Luc W Eurlings, Sandra Sanders-van Wijk, Roland van Kimmenade, Aart Osinski, Lidwien van Helmond, Maud Vallinga, Harry J Crijns, Marja P van Dieijen-Visser, Hans-Peter Brunner-La Rocca, and Yigal M Pinto.
• Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, the Netherlands. l.eurlings@mumc.nl
• J. Am. Coll. Cardiol. 2012 Oct 23;60(17):1668-77.

ObjectivesThe study aim was to determine the prognostic value of a multimarker strategy for risk-assessment in patients presenting to the emergency department (ED) with dyspnea.BackgroundCombining biomarkers with different pathophysiological backgrounds may improve risk stratification in dyspneic patients in the ED.MethodsThe study prospectively investigated the prognostic value of the biomarkers N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), Cystatin-C (Cys-C), high-sensitivity C-reactive protein (hs-CRP), and Galectin-3 (Gal-3) for 90-day mortality in 603 patients presenting to the ED with dyspnea as primary complaint.Resultshs-CRP, hs-cTnT, Cyst-C, and NT-proBNP were independent predictors of 90-day mortality. The number of elevated biomarkers was highly associated with outcome (odds ratio: 2.94 per biomarker, 95% confidence interval [CI]: 2.29 to 3.78, p < 0.001). A multimarker approach had incremental value beyond a single-marker approach. Our multimarker emergency dyspnea-risk score (MARKED-risk score) incorporating age ≥75 years, systolic blood pressure <110 mm Hg, history of heart failure, dyspnea New York Heart Association functional class IV, hs-cTnT ≥0.04 μg/l, hs-CRP ≥25 mg/l, and Cys-C ≥1.125 mg/l had excellent prognostic performance (area under the curve: 0.85, 95% CI: 0.81 to 0.89), was robust in internal validation analyses and could identify patients with very low (<3 points), intermediate (≥3, <5 points), and high risk (≥5 points) of 90-day mortality (2%, 14%, and 44% respectively; p < 0.001).ConclusionsA multimarker strategy provided superior risk stratification beyond any single-marker approach. The MARKED-risk score that incorporates hs-cTnT, hs-CRP, and Cys-C along with clinical risk factors accurately identifies patients with very low, intermediate, and high risk.Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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