This is the “MARKED” score, a multi-marker prognostic risk score derived from emergency department patients presenting with acute dyspnea. The authors state they’ve presented a “simple, straightforward” score that “may help the treating physician at the ED to decide on urge of intervention, admission, and timing of re-evaluation.”
Sounds perfect! A valuable tool to determine which patients are at high-risk for short-term mortality, possibly to predict which patients may have unanticipated poor outcomes if discharged home?
Ah, sadly, no.
When these cardiologists risk-stratify heart failure, they’re using 90-day mortality – an endpoint almost certainly irrelevant to acute evaluation of dyspnea. The authors recognize the “single-center” aspect of their study as a limitation – but, considering this comes from a dedicated “cardiology ED” in Holland, the external validity is extraordinarily limited. The authors also do not offer any practical suggestion regarding how this score might be used in practice – or how decision-making using this score effectively changes outcomes compared with usual care.
Finally, this “simple” score features the commonly used laboratory tests such as NT-proBNP, high-sensitivty cardiac troponin T, Cystatin-C, high-sensitivity C-reactive protein, and Galectin-3. It should be no surprise a few authors receive compensation from Roche Diagnostics and ACS Biomarker B.V.
“Multimarker Strategy for Short-Term Risk Assessment in Patients With Dyspnea in the Emergency Department”
www.ncbi.nlm.nih.gov/pubmed/23021334