Abstract 112: Asymmetric Dimethylarginine Predicts Outcome and Time of Stay in Hospital in Patients Attending an Internal Medicine Emergency Room
Introduction For patients attending the emergency room (ER) valid diagnostic criteria which give information about further progress are needed. We investigated the predictive value of asymmetric dimethylarginine (ADMA), an independent cardiovascular risk factor, in unselected patients attending the internal medicine ER of a university medical center regarding outcome of the patients and duration of stay in the hospital.
Patients and Methods Patients (n=417) attending the ER were classified according their primary diagnosis in six groups: cardiovascular (n=156), pulmonary (n=31), CNS/neurological (n=42), gastrointestinal (n=84), cancer related (n=26), other diagnosis (n=78). Routine laboratory tests were performed and ADMA was determined by LC-MS from plasma. A primary endpoint of in hospital death and complicated outcome (need for continuous hospital based support) was defined.
Results ADMA levels were highest in patients with cancer related diagnosis (0.84± 0.36 μmol/L) and in patients with cardiovascular diagnosis (0.71±0.19 μmol/L) (ANOVA; p<0.001). In patients with cardiovascular diagnosis those reaching the primary endpoint had significantly higher ADMA levels than those without complications (0.88±0.22 μmol/L vs. 0.69±0.18; p<0.001). We found increasing proportions of patients experiencing the primary endpoint over the quartiles of ADMA (4.6%, 8.2%, 9.6%, and 15.8%; p=0.007). ADMA was an independent predictor of the primary endpoint in a multivariate linear regression model (odds ratio 16.8; p=0.038) after correction for age, gender, laboratory parameters, and chronic cardiovascular diseases. In a Cox proportional hazard model correcting for gender, BMI, diabetes, hypertension, CHD, and heart failure, ADMA was an independent predictor of the length of hospitalization (hazard ratio (HR) 0.49 (95% CI: 0.30 – 0.81); p=0.005) beside age (HR 0.99 (0.98 –9.99); p=0.031), creatinine (HR 0.87 (0.77– 0.99); p=0.035), and CRP (HR 0.94 (0.91– 0.96); p<0.001) in patients with cardiovascular diagnosis, respectively.
Conclusion We conclude that ADMA independently predicts future complications and hospitalization in patients attending an ER.