{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T11:14:52Z","timestamp":1765710892802,"version":"3.48.0"},"reference-count":41,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T00:00:00Z","timestamp":1672012800000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,10,17]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to estimate the association of the often, in daily clinical practice, used biological age-related biomarkers high-sensitivity troponin-T (hs-TnT), C reactive protein (CRP) and haemoglobin (Hb) with all-cause mortality for the purpose of older patient\u2019s risk stratification in the emergency department (ED).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Exploratory, prospective cohort study with a follow-up at 2.5 years after recruitment started. For the predictors, data from the hospital files including the routinely applied biological age-related biomarkers hs-TnT, CRP and Hb were supplemented by a questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A cardiological ED, Chest Pain Unit, University Hospital Heidelberg, Germany.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>N=256 cardiological ED patients with a minimum age of 70 years and the capability to informed consent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome of this study was all-cause mortality which was assessed by requesting registry office information.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among N=256 patients 63 died over the follow-up period. Positive results in each of the three biomarkers alone as well as the combination were associated with increased all-cause mortality at follow-up. The number of positive age-related biomarkers appeared to be strongly indicative of the risk of mortality, even when controlled for major confounders (age, sex, body mass index, creatinine clearance and comorbidity).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In older ED patients, biomarkers explicitly related to biological ageing processes such as hs-TnT, CRP and Hb were to a certain degree independently of each other as well as combined associated with an increased risk of all-cause mortality. Thus, they may have the potential to be used to supplement the general risk stratification of older patients in the ED. Validation of the results in a large dataset is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-056674","type":"journal-article","created":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T10:41:47Z","timestamp":1672051307000},"page":"e056674","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring biomarkers in routine diagnostics for the risk stratification of older patients in the Chest Pain Unit: a prospective cohort study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2759-0261","authenticated-orcid":false,"given":"Anna Lisa","family":"Kunz","sequence":"first","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton","family":"Sch\u00f6nstein","sequence":"additional","affiliation":[{"name":"Network Aging Research, Heidelberg University, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5894-3402","authenticated-orcid":false,"given":"Philipp","family":"Bahrmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1025-2872","authenticated-orcid":false,"given":"Evangelos","family":"Giannitsis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Werner","family":"Wahl","sequence":"additional","affiliation":[{"name":"Network Aging Research and Institute of Psychology, Heidelberg University, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo A","family":"Katus","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"Frey","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anke","family":"Bahrmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany"},{"name":"Network Aging Research, Heidelberg University, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,12,26]]},"reference":[{"key":"2025121403131282000_12.12.e056674.1","doi-asserted-by":"crossref","unstructured":"Aminzadeh F DWB . Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions; 2002 [Accessed 02 Nov 2019].","DOI":"10.1067\/mem.2002.121523"},{"key":"2025121403131282000_12.12.e056674.2","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-007-0081-3"},{"key":"2025121403131282000_12.12.e056674.3","doi-asserted-by":"crossref","DOI":"10.3390\/nu8060338","article-title":"Biomarkers of aging: from function to molecular biology","volume":"8","author":"Wagner","year":"2016","journal-title":"Nutrients"},{"key":"2025121403131282000_12.12.e056674.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.yexmp.2005.11.004"},{"key":"2025121403131282000_12.12.e056674.5","doi-asserted-by":"crossref","unstructured":"Zimmermann J , Herrlinger S , Pruy A , et al . Inflammation enhances cardiovascular risk and mortality in hemodialysis patients, 1999. Available: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0085253815460090 [Accessed 13 Oct 2019].","DOI":"10.1046\/j.1523-1755.1999.00273.x"},{"key":"2025121403131282000_12.12.e056674.6","doi-asserted-by":"crossref","unstructured":"Ridker PM , Cushman M , Stampfer MJ , et al . Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. NEJM 2009.doi:10.1056\/NEJM199704033361401","DOI":"10.1056\/NEJM199704033361401"},{"key":"2025121403131282000_12.12.e056674.7","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13033"},{"key":"2025121403131282000_12.12.e056674.8","unstructured":"Bardaji A , Cediel G , Carrasquer A , et al . Troponin elevation in patients without acute coronary syndrome, 2015. Available: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S188558571500033X [Accessed 13 Oct 2019]."},{"key":"2025121403131282000_12.12.e056674.9","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2013-202865"},{"key":"2025121403131282000_12.12.e056674.10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1708"},{"key":"2025121403131282000_12.12.e056674.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l6055"},{"key":"2025121403131282000_12.12.e056674.12","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-10-4308"},{"key":"2025121403131282000_12.12.e056674.13","doi-asserted-by":"crossref","first-page":"151","DOI":"10.4082\/kjfm.17.0089","article-title":"Mild anemia and risk for all-cause, cardiovascular and cancer deaths in apparently healthy elderly Koreans","volume":"40","author":"Han","year":"2019","journal-title":"Korean J Fam Med"},{"key":"2025121403131282000_12.12.e056674.14","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090040"},{"key":"2025121403131282000_12.12.e056674.15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1975.tb00927.x"},{"key":"2025121403131282000_12.12.e056674.16","doi-asserted-by":"crossref","unstructured":"Luppa PB , Steimer W . Referenzwerte der wichtigsten Laborparameter, 2020. Available: https:\/\/link.springer.com\/chapter\/10.1007\/978-3-662-54507-2_159#citeas [Accessed 11 Jun 2020].","DOI":"10.1007\/978-3-662-54507-2_159"},{"key":"2025121403131282000_12.12.e056674.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00136-3"},{"key":"2025121403131282000_12.12.e056674.18","doi-asserted-by":"publisher","DOI":"10.1373\/49.4.666"},{"key":"2025121403131282000_12.12.e056674.19","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2009.132654"},{"key":"2025121403131282000_12.12.e056674.20","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ijcard.2016.01.213","article-title":"Diagnostic and prognostic implications using age- and gender-specific cut-offs for high-sensitivity cardiac troponin T - Sub-analysis from the TRAPID-AMI study","volume":"209","author":"Mueller-Hennessen","year":"2016","journal-title":"Int J Cardiol"},{"key":"2025121403131282000_12.12.e056674.21","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.13449"},{"key":"2025121403131282000_12.12.e056674.22","unstructured":"Weltgesundheitsorganisation . Research into environmental pollution: report of five WHO scientific groups. Geneva: World Health Organization, 1968."},{"key":"2025121403131282000_12.12.e056674.23","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(94)90129-5"},{"key":"2025121403131282000_12.12.e056674.24","doi-asserted-by":"publisher","DOI":"10.1159\/000180580"},{"key":"2025121403131282000_12.12.e056674.25","doi-asserted-by":"publisher","DOI":"10.1177\/2048872614541904"},{"key":"2025121403131282000_12.12.e056674.26","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfs109"},{"key":"2025121403131282000_12.12.e056674.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2012.12.005"},{"key":"2025121403131282000_12.12.e056674.28","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.2169\/internalmedicine.0098-17","article-title":"The usefulness and limitations of point-of-care cardiac troponin measurement in the emergency department","volume":"57","author":"Suzuki","year":"2018","journal-title":"Intern Med"},{"key":"2025121403131282000_12.12.e056674.29","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-042989"},{"key":"2025121403131282000_12.12.e056674.30","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-015112"},{"key":"2025121403131282000_12.12.e056674.31","doi-asserted-by":"publisher","DOI":"10.1152\/physiol.00040.2007"},{"key":"2025121403131282000_12.12.e056674.32","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.19.2214"},{"key":"2025121403131282000_12.12.e056674.33","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1515\/cclm-2012-0401","article-title":"Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department","volume":"51","author":"Bahrmann","year":"2013","journal-title":"Clin Chem Lab Med"},{"key":"2025121403131282000_12.12.e056674.34","unstructured":"American Federation for Aging Research . Biomarkers of aging, 2016. Available: https:\/\/www.afar.org\/imported\/AFAR_BIOMARKERS_OF_AGING_2016.pdf"},{"key":"2025121403131282000_12.12.e056674.35","doi-asserted-by":"crossref","DOI":"10.1016\/j.exger.2020.111184","article-title":"Geriatric assessment for older adults admitted to the emergency department: a systematic review and meta-analysis","volume":"144","author":"H\u00e4seler-Ouart","year":"2021","journal-title":"Exp Gerontol"},{"key":"2025121403131282000_12.12.e056674.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.12.068"},{"key":"2025121403131282000_12.12.e056674.37","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1999.tb05204.x"},{"key":"2025121403131282000_12.12.e056674.38","first-page":"179","article-title":"Adverse outcomes in older adults attending emergency departments: a systematic review and meta-analysis of the identification of seniors at risk (ISAR) screening tool","volume":"46","author":"Galvin","year":"2017","journal-title":"Age Ageing"},{"key":"2025121403131282000_12.12.e056674.39","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12569"},{"key":"2025121403131282000_12.12.e056674.40","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s00391-019-01626-z","article-title":"SPMSQ zur Risikostratifizierung \u00e4lterer Patienten in der Notaufnahme Eine explorative prospektive Kohortenstudie","volume":"52","author":"Sch\u00f6nstein","year":"2019","journal-title":"Z Gerontol Geriatr"},{"key":"2025121403131282000_12.12.e056674.41","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa624"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-056674","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T11:13:17Z","timestamp":1765710797000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-056674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12,26]]},"published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1136\/bmjopen-2021-056674"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-056674","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2022,12]]}}}