Diagnostic and prognostic markers in patients admitted to an emergency department

Abstract

The emergency physician's ability to quickly diagnose and make a prognosis about the evolution of a seriously ill patient can not only save lives but also help to reduce the burden on medical services. Unfortunately, not all diseases have specific markers that can help physicians in this decision (as is the case of troponin in patients with acute myocardial infarction). So our main goal is to determine scores or serum dosages that can be useful as diagnosis and/or prognosis markers in critically ill patients at an Emergency Department. This is an observational, prospective study, to be conducted with patients admitted to the Emergency Department (PSM) HCFMUSP. Patients will be screened for one of the seven subprojects according to their diagnosis on admission: 1. Inflammatory and brain injury serum markers in patients with diffuse encephalopathy (delirium): elderly patients with decreased level of consciousness, without acute structural brain injury, will be evaluated for the presence of inflammatory (cytokines, chemokines) or brain injury (S100B, NSE, etc.) markers to serve as diagnostic or prognosis markers of outcome; 2. Endogenous corticosteroids in patients with severe community-acquired pneumonia our hypothesis is that an inadequate function of the hypothalamic-pituitaryadrenal-intracellular receptors axis may be a cause of poor outcome in patients with pneumonia. We will evaluate the functioning of this axis, as wellas the intracellular mediators of corticosteroids signaling, which will be correlated to clinical outcomes; 3. Influence of serum albumin in dosages of circulating inflammatory mediators the hypothesis is that cytokines may circulate in free or albumin-bound form. We intend to determine the veracity of this hypothesis and whether these two forms, alone or together, can serve as sepsis prognostic predictors; 4. Scores of palliative care and outcome in patients admitted to Emergency Department the correct evaluation of terminal illness and prescription of end of life care in patients with end-stage chronic diseases is a necessity, although the current scores are very flawed. Our goal is to determine what are the best scores and to develop new ones, including serum markers that could be used in the initial approach to the patient in the emergency department. 5. Volume replacement in sepsis patients. Sepsis patients today receive large amounts of intravenous volume to recover hemodynamic stability. Recents suggest that this volume should be restricted. Thus, it is our goal to compare mortality in patients receiving standard volume resuscitation (30ml / kg) and using a fluid response-guided protocol 6. Role of echocardiography in patients with bacteremia caused by Staphylococcus Bacteremia caused by Staphylococci is a serious disease and many patients have associated endocarditis passing undiagnosed. We intend to perform a retrospective analysis and identify criteria that could indicate that the patient would benefit of an echocardiography at the time of admission. 7. Predictors of hospital readmission the goal is to identify predictors of readmission at 30 days in patients admitted in an emergency service. In all subprojects patients will be submitted to specific questionnaires and blood samples on admission. Dosages of specific markers of all subprojects will be held at LIM51, FMUSP. Clinical outcome during hospitalization or within 30 days of discharge from all patients included in the seven studies will be obtained: mortality, length of hospital stay, readmission, organ failure. Statistical analysis will be performed to identify correlation between scores or serum markers obtained at admission and outcomes. The data obtained in this project will be of great value in attending to critical patients in emergency services throughout the country. (AU)