# Nonspecific stress biomarkers for mortality prediction in older emergency department patients presenting with falls: a prospective multicenter observational study

## TL;DR

This study found that D-dimer and MR-proADM levels can help predict short-term mortality in older patients who fall and visit the emergency department.

## Contribution

The study introduces D-dimer and MR-proADM as potential nonspecific stress biomarkers for mortality prediction in elderly fall patients.

## Key findings

- Elevated MR-proADM and D-dimer levels were associated with higher mortality risk in older fall patients.
- D-dimer and MR-proADM showed high sensitivity and low negative likelihood ratio for short-term mortality.
- Copeptin was not significantly associated with mortality risk in this population.

## Abstract

Older 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.

Prospective, 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.

Five 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.

D-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.

ClinicalTrials.gov Identifier: NCT02244983.

The online version contains supplementary material available at 10.1007/s11739-024-03693-6.