INTRODUCTION: Early risk stratification in the @entity341 ( @entity341 ) is vital to reduce time to effective treatment in high-risk @entity1 and to improve @entity1 flow. Yet, there is a lack of investigations evaluating the incremental usefulness of multiple biomarkers measured upon admission from distinct biological pathways for predicting fatal outcome and high initial treatment urgency in unselected @entity341 @entity1 in a multicenter and multinational setting. METHOD: We included consecutive, adult, medical @entity1 seeking @entity341 care into this observational, cohort study in Switzerland, France and the USA. We recorded initial clinical parameters and batch-measured prognostic biomarkers of @entity32 (pro-adrenomedullin [ProADM]), stress (copeptin) and @entity281 (procalcitonin). RESULTS: During a 30-day follow-up, 331 of 7132 (4.6  %) @entity1 reached the primary endpoint of @entity204 within 30  days. In logistic regression models adjusted for conventional risk factors available at @entity341 admission, all three biomarkers strongly predicted the risk of @entity204 (AUC 0.83, 0.78 and 0.75), ICU admission (AUC 0.67, 0.69 and 0.62) and high initial triage priority (0.67, 0.66 and 0.58). For the prediction of @entity204 , ProADM significantly improved regression models including (a) clinical information available at @entity341 admission (AUC increase from 0.79 to 0.84), (b) full clinical information at @entity341 discharge (AUC increase from 0.85 to 0.88), and (c) triage information (AUC increase from 0.67 to 0.83) (p <0.01 for each comparison). Similarly, ProADM also improved clinical models for prediction of ICU admission and high initial treatment urgency. Results were robust in regard to predefined @entity1 subgroups by center, main diagnosis, presenting symptoms, age and gender. CONCLUSIONS: Combination of clinical information with results of blood biomarkers measured upon @entity341 admission allows early and more adequate risk stratification in individual unselected medical @entity341 @entity1 . A randomized trial is needed to answer the question whether biomarker-guided initial @entity1 triage reduces time to initial treatment of high-risk @entity1 in the @entity341 and thereby improves @entity1 flow and clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01768494 . Registered January 9, 2013.

Biomarkers from distinct biological pathways improve early risk stratification in medical emergency XXXX : the multinational, prospective, observational TRIAGE study.

@entity1 :: ('9606', 'Species') :: ['participants', 'patients', 'patient'] @entity32 :: ('MESH:D007249', 'Disease') :: ['inflammation'] @entity341 :: ('MESH:D004630', 'Disease') :: ['emergency department', 'ED'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death']
@entity1 :: (9606,Species) :: ['patients']
