TITLE:
Potential Role of Biomarkers in the Management of Syncope
AUTHORS:
Birsen Arici, Mirjam Maeder, Philipp Schuetz, Beat Muelle, Werner C. Albrich
KEYWORDS:
Blood Biomarkers; Syncope; San Francisco Syncope Rule
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.3 No.7A,
January
2,
2013
ABSTRACT: Study objective: Syncope is one of the
most common presentation of patients seen in emergency departments (ED). Risk
assessment of syncope is challenging. The San Francisco Syncope Rule is the
most widely used risk assessment, but has moderate accuracy. The aim of our
study was to investigate blood biomarkers as prognostic factors for adverse outcome. Methods: In this observational study we
included consecutive adults presenting with syncope to our ED. Management decisions
were left to the discretion of the treating physicians. Patients were monitored
for adverse events until discharge and underwent a phone interview 30 days
after enrolment. Adverse outcome was defined as recurrent syncope,
rehospitalization and death within 30 days. Results: We included 132 adult patients of whom 19 (14%) had an
adverse event (recurrent syncope = 3, rehospitalisation = 12, death = 4). No difference in the San Francisco Syncope Rule was found in patients
with and without adverse events (SFSR ≥ 1: 37% vs. 39%, p = 0.877). Median
levels of ProADM (1.23 vs. 0.81 nmol/l; p =
0.006) and NT-proBNP (454 vs 134ng/l; p = 0.035) were higher and median levels
for cholesterol (3.68 vs 4.57 mmol/l; p = 0.008) and prealbumin (0.19 vs0.26 g/l;
p = 0.005) were lower in patients with adverse events. Prealbumin (AUC 0.72) and ProADM (AUC 0.70) had the highest
prognostic accuracy. Conclusion: Biomarkers predicted poor outcome and might be helpful in
the context of a clinical algorithm for an improved triage of syncope patients
in the ED.