• Nathalie Lund, Klas Gränsbo, Camilla Wernersson, and Olle Melander.
• Skåne University Hospital Malmö, Clinical Research Centre, Malmoe, Sweden. Electronic address: nathalie.lund@med.lu.se.
• Am J Emerg Med. 2017 Apr 1; 35 (4): 610-614.

BackgroundAcute dyspnea affects a large heterogeneous patient group with high mortality and readmission rates.PurposeTo investigate if cardiometabolic biomarkers and clinical characteristics predict readmission and death in patients hospitalized for acute dyspnea.Methods65 dyspnea patients at a general internal medicine ward were followed for six months. The combined endpoint was readmission or death.Measurements And ResultsCardiometabolic biomarkers at admission were related to the endpoint in Cox proportional hazard models (adjusted for sex, age, oxygen saturation, respiratory rate and C-reactive protein (CRP)). The biomarkers tissue-type plasminogen activator (tPA), prolactin (PRL), tumor necrosis factor receptor superfamily member 6 (FAS) and C-C motif chemokine 3 (CCL3) were independently and significantly related to the endpoint and combined into a biomarker risk score (BRS). Each SD increment of the BRS conferred a hazard ratio (HR) of 2.13 (1.39-3.27) P=0.001. The top vs bottom tertile of the BRS conferred a HR of 4.75 (1.93-11.68) P=0.001. Dyspnea severity was also associated with worse outcome, HR=3.43 (1.28-9.20) P=0.014. However, when mutually adjusted the BRS remained significant (P=0.004) whereas dyspnea severity was not. The BRS was related to the endpoint among patients with mild to moderate dyspnea (P=0.016) but not among those with severe dyspnea.ConclusionA score of tPA, PRL, FAS and CCL3 predicts 6-month death and readmission in patients hospitalized for acute dyspnea and may prove useful to optimize length of stay and follow-up. Although the BRS outweighs dyspnea severity in prediction of the endpoint, its prognostic role is strongest in mild-moderate dyspnea.Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

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