Prognostic power of biomarkers for short-term mortality in the elderly patients seen in Emergency Departments due to infections

Enferm Infecc Microbiol Clin. 2019 Jan;37(1):11-18. doi: 10.1016/j.eimc.2017.11.017. Epub 2017 Dec 27.
[Article in En, Spanish]


Objectives: To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate, suPAR and pro-adremomedullin) in elderly patients seen in Emergency Departments (ED) due to infections. Secondly, if these could improve the prognostic accuracy of sepsis criteria (systemic inflammatory response syndrome and quick Sepsis-related Organ Failure Assessment [qSOFA]).

Methods: A prospective, observational, multicentre and analytical study. Patients aged 75 years and older who were treated for infection in the ED of 8 participating hospitals were enrolled consecutively. An assessment was made of 25 independent variables (epidemiological, comorbidity, functional, clinical and analytical variables) that could influence short-term mortality (at 30 days).

Results: The study included 136 patients, 13 (9.5%) of whom died within 30 days of visiting the ED. MR-proADM is the biomarker with the best area under the curve ROC to predict 30-day mortality (0.864; 95% CI 0.775-0.997; P<.001) with a prognostic cut-off>2.07nmol/l, sensitivity of 77% and specificity of 96%. The qSOFA score≥2 had an area under the curve ROC of 0.763 (95% CI 0.623-0.903; P=.002), sensitivity of 76% and specificity of 75%. The mixed model (MR-proADM plus qSOFA≥2) improved the area under the curve ROC to 0.878 (95% CI 0.749-1; P<.001) with the best prognostic performance with sensitivity of 69% and specificity of 97% CONCLUSIONS: MR-proADM showed the best performance for 30-day mortality prognostic power compared to other biomarkers in elderly patients seen in EDs due to infections. qSOFA score achieves better results than systemic inflammatory response syndrome, and the mixed model (qSOFA≥2 plus MR-proADM>2.07nmol/l) increased the predictive power of qSOFA.

Keywords: Anciano; Biomarcadores; Biomarkers; C-reactive protein; Elderly; Emergency Department; Lactate; Lactato; Mortalidad; Mortality; Pro-adrenomedullin; Proadrenomedulina; Procalcitonin; Procalcitonina; Prognosis; Pronóstico; Proteína C reactiva; Receptor soluble del activador del plasminógeno de tipo urocinasa; Servicio de Urgencias; Soluble urokinase-type plasminogen activator receptor.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged, 80 and over
  • Biomarkers / blood
  • Emergency Service, Hospital
  • Female
  • Hospital Mortality
  • Humans
  • Infections / blood
  • Infections / complications
  • Infections / mortality*
  • Male
  • Organ Dysfunction Scores
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Systemic Inflammatory Response Syndrome / blood
  • Systemic Inflammatory Response Syndrome / etiology
  • Time Factors


  • Biomarkers