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.
Highlights
Syncope is a common symptom among patients presenting to emergency departments (EDs) [1]
Medical history did not differ in both groups except for arrhythmia, which was more common in patients with adverse events (37% vs 15%, p = 0.039)
Median levels of prealbumin did not differ in the various causes of syncope (0.26, 0.23, 0.26 vs 0.24; p = 0.06). In this observational study of patients presenting with syncope to the ED of a Swiss medical university hospital we found prealbumin and ProADM to be predictors of adverse outcome during a 30-days follow-up
Summary
Syncope is a common symptom among patients presenting to emergency departments (EDs) [1]. The most frequently identified cause of syncope is neurally-mediated (neurocardiogenic syncope), which is not associated with an increased risk of cardiovascular morbidity and mortality. On the other hand risk of death is doubled among patients with cardiac syncope as compared to those without syncope [2]. Short-term serious adverse events are rare, more than half of patients are hospitalized for evaluation according to European Society of Cardiology (ESC) guidelines [3] and 25% of the patients are hospitalized without clear indication [4]. Several predictors of short-term serious events after syncope and clinical decision rules in syncope-evaluation have been described [7,8,9].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
