Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III)
Abstract Background Risk stratification of patients in the emergency department can be strengthened using prognostic biomarkers, but the impact on patient prognosis is unknown. The aim of the TRIAGE III trial was to investigate whether the introduction of the prognostic and nonspecific biomarker: so...
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2018-08-01
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Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
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Online Access: | http://link.springer.com/article/10.1186/s13049-018-0539-5 |
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Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Martin Schultz Line Jee Hartmann Rasmussen Malene H. Andersen Jakob S. Stefansson Alexander C. Falkentoft Morten Alstrup Andreas Sandø Sarah L. K. Holle Jeppe Meyer Peter B. S. Törnkvist Thomas Høi-Hansen Erik Kjøller Birgitte Nybo Jensen Morten Lind Lisbet Ravn Thomas Kallemose Theis Lange Lars Køber Lars Simon Rasmussen Jesper Eugen-Olsen Kasper Karmark Iversen |
spellingShingle |
Martin Schultz Line Jee Hartmann Rasmussen Malene H. Andersen Jakob S. Stefansson Alexander C. Falkentoft Morten Alstrup Andreas Sandø Sarah L. K. Holle Jeppe Meyer Peter B. S. Törnkvist Thomas Høi-Hansen Erik Kjøller Birgitte Nybo Jensen Morten Lind Lisbet Ravn Thomas Kallemose Theis Lange Lars Køber Lars Simon Rasmussen Jesper Eugen-Olsen Kasper Karmark Iversen Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III) Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Prognostic biomarkers Risk stratification Emergency department |
author_facet |
Martin Schultz Line Jee Hartmann Rasmussen Malene H. Andersen Jakob S. Stefansson Alexander C. Falkentoft Morten Alstrup Andreas Sandø Sarah L. K. Holle Jeppe Meyer Peter B. S. Törnkvist Thomas Høi-Hansen Erik Kjøller Birgitte Nybo Jensen Morten Lind Lisbet Ravn Thomas Kallemose Theis Lange Lars Køber Lars Simon Rasmussen Jesper Eugen-Olsen Kasper Karmark Iversen |
author_sort |
Martin Schultz |
title |
Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III) |
title_short |
Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III) |
title_full |
Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III) |
title_fullStr |
Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III) |
title_full_unstemmed |
Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III) |
title_sort |
use of the prognostic biomarker supar in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (triage iii) |
publisher |
BMC |
series |
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
issn |
1757-7241 |
publishDate |
2018-08-01 |
description |
Abstract Background Risk stratification of patients in the emergency department can be strengthened using prognostic biomarkers, but the impact on patient prognosis is unknown. The aim of the TRIAGE III trial was to investigate whether the introduction of the prognostic and nonspecific biomarker: soluble urokinase plasminogen activator receptor (suPAR) for risk stratification in the emergency department reduces mortality in acutely admitted patients. Methods The TRIAGE III trial was a cluster-randomized interventional trial conducted at emergency departments in the Capitol Region of Denmark. Eligible hospitals were required to have an emergency department with an intake of acute medical and surgical patients and no previous access to suPAR measurement. Three emergency departments were randomized; one withdrew shortly after the trial began. The inclusion period was from January through June of 2016 consisting of twelve cluster-periods of 3-weeks alternating between intervention and control and a subsequent follow-up of ten months. Patients were allocated to the intervention if they arrived in interventional periods, where suPAR measurement was routinely analysed at arrival. In the control periods suPAR measurement was not performed. The main outcome was all-cause mortality 10 months after arrival of the last patient in the inclusion period. Secondary outcomes included 30-day mortality. Results The trial enrolled a consecutive cohort of 16,801 acutely admitted patients; all were included in the analyses. The intervention group consisted of 6 cluster periods with 8900 patients and the control group consisted of 6 cluster periods with 7901 patients. After a median follow-up of 362 days, death occurred in 1241 patients (13.9%) in the intervention group and in 1126 patients (14.3%) in the control group. The weighted Cox model found a hazard ratio of 0.97 (95% confidence interval, 0.89 to 1.07; p = 0.57). Analysis of all subgroups and of 30-day all-cause mortality showed similar results. Conclusions The TRIAGE III trial found no effect of introducing the nonspecific and prognostic biomarker suPAR in emergency departments on short- or long-term all-cause mortality among acutely admitted patients. Further research is required to evaluate how prognostic biomarkers can be implemented in routine clinical practice. Trial registration clinicaltrials.gov, NCT02643459. Registered 31 December 2015. |
topic |
Prognostic biomarkers Risk stratification Emergency department |
url |
http://link.springer.com/article/10.1186/s13049-018-0539-5 |
work_keys_str_mv |
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doaj-94d6bb950b2545d4801f189df0e563e42020-11-25T02:13:09ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412018-08-0126111010.1186/s13049-018-0539-5Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III)Martin Schultz0Line Jee Hartmann Rasmussen1Malene H. Andersen2Jakob S. Stefansson3Alexander C. Falkentoft4Morten Alstrup5Andreas Sandø6Sarah L. K. Holle7Jeppe Meyer8Peter B. S. Törnkvist9Thomas Høi-Hansen10Erik Kjøller11Birgitte Nybo Jensen12Morten Lind13Lisbet Ravn14Thomas Kallemose15Theis Lange16Lars Køber17Lars Simon Rasmussen18Jesper Eugen-Olsen19Kasper Karmark Iversen20Department of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenClinical Research Centre, Amager and Hvidovre Hospital, University of CopenhagenDepartment of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenDepartment of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of CopenhagenDepartment of Cardiology, Rigshospitalet, University of CopenhagenDepartment of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenDepartment of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenDepartment of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenClinical Research Centre, Amager and Hvidovre Hospital, University of CopenhagenClinical Research Centre, Amager and Hvidovre Hospital, University of CopenhagenDepartment of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenDepartment of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenDepartment of Emergency Medicine, Bispebjerg Hospital, University of CopenhagenDepartment of Emergency Medicine, Herlev and Gentofte Hospital, University of CopenhagenDepartment of Emergency Medicine, Herlev and Gentofte Hospital, University of CopenhagenClinical Research Centre, Amager and Hvidovre Hospital, University of CopenhagenDepartment of Public Health, University of Copenhagen, Section of biostatisticsDepartment of Cardiology, Rigshospitalet, University of CopenhagenDepartment of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of CopenhagenClinical Research Centre, Amager and Hvidovre Hospital, University of CopenhagenDepartment of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenAbstract Background Risk stratification of patients in the emergency department can be strengthened using prognostic biomarkers, but the impact on patient prognosis is unknown. The aim of the TRIAGE III trial was to investigate whether the introduction of the prognostic and nonspecific biomarker: soluble urokinase plasminogen activator receptor (suPAR) for risk stratification in the emergency department reduces mortality in acutely admitted patients. Methods The TRIAGE III trial was a cluster-randomized interventional trial conducted at emergency departments in the Capitol Region of Denmark. Eligible hospitals were required to have an emergency department with an intake of acute medical and surgical patients and no previous access to suPAR measurement. Three emergency departments were randomized; one withdrew shortly after the trial began. The inclusion period was from January through June of 2016 consisting of twelve cluster-periods of 3-weeks alternating between intervention and control and a subsequent follow-up of ten months. Patients were allocated to the intervention if they arrived in interventional periods, where suPAR measurement was routinely analysed at arrival. In the control periods suPAR measurement was not performed. The main outcome was all-cause mortality 10 months after arrival of the last patient in the inclusion period. Secondary outcomes included 30-day mortality. Results The trial enrolled a consecutive cohort of 16,801 acutely admitted patients; all were included in the analyses. The intervention group consisted of 6 cluster periods with 8900 patients and the control group consisted of 6 cluster periods with 7901 patients. After a median follow-up of 362 days, death occurred in 1241 patients (13.9%) in the intervention group and in 1126 patients (14.3%) in the control group. The weighted Cox model found a hazard ratio of 0.97 (95% confidence interval, 0.89 to 1.07; p = 0.57). Analysis of all subgroups and of 30-day all-cause mortality showed similar results. Conclusions The TRIAGE III trial found no effect of introducing the nonspecific and prognostic biomarker suPAR in emergency departments on short- or long-term all-cause mortality among acutely admitted patients. Further research is required to evaluate how prognostic biomarkers can be implemented in routine clinical practice. Trial registration clinicaltrials.gov, NCT02643459. Registered 31 December 2015.http://link.springer.com/article/10.1186/s13049-018-0539-5Prognostic biomarkersRisk stratificationEmergency department |