Endostatin predicts mortality in patients with acute dyspnea - A cohort study of patients seeking care in emergency departments

Clin Biochem. 2020 Jan:75:35-39. doi: 10.1016/j.clinbiochem.2019.10.004. Epub 2019 Oct 28.


Background: Increased levels of circulating endostatin predicts cardiovascular morbidity and impaired kidney function in the general population. The utility of endostatin as a risk marker for mortality in the emergency department (ED) has not been reported.

Aim: Our main aim was to study the association between plasma endostatin and 90-day mortality in an unselected cohort of patients admitted to the ED for acute dyspnea. Design Circulating endostatin was analyzed in plasma from 1710 adults and related to 90-day mortality in Cox proportional hazard models adjusted for age, sex, body mass index, oxygen saturation, respiratory rate, body temperature, C-reactive protein, lactate, creatinine and medical priority according to the Medical Emergency Triage and Treatment System-Adult score (METTS-A). The predictive value of endostatin for mortality was evaluated with receiver operating characteristic (ROC) analysis and compared with the clinical triage scoring system and age.

Results: Each one standard deviation increment of endostatin was associated with a HR of 2.12 (95% CI 1.31-3.44 p < 0.01) for 90-day mortality after full adjustment. Levels of endostatin were significantly increased in the group of patients with highest METTS-A (p < 0.001). When tested for the outcome 90-day mortality, the area under the ROC curve (AUC) was 0.616 for METTS-A, 0.701 for endostatin, 0.708 for METTS -A and age and 0.738 for METTS-A, age and levels of endostatin.

Conclusions: In an unselected cohort of patients admitted to the ED with acute dyspnea, endostatin had a string association to 90-day mortality and improved prediction of 90-day mortality in the ED beyond the clinical triage scoring system and age with 3%.

Keywords: Acute dyspnea; Cardiovascular; Emergency department; Endostatin; Epidemiology; METTS-A; Mortality.

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Cohort Studies
  • Dyspnea / blood
  • Dyspnea / mortality*
  • Emergency Service, Hospital
  • Endostatins / blood*
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged


  • Biomarkers
  • Endostatins