Using soluble urokinase plasminogen activator receptor to stratify patients for medication review in the emergency department

Anne Kathrine Bengaard; Esben Iversen; Thomas Kallemose; Helle Gybel Juul-Larsen; Line Jee Hartmann Rasmussen; Kim Peder Dalhoff; Ove Andersen; Jesper Eugen-Olsen; Morten Baltzer Houlind

doi:10.1111/bcp.14982

Using soluble urokinase plasminogen activator receptor to stratify patients for medication review in the emergency department

Br J Clin Pharmacol. 2022 Feb;88(4):1679-1690. doi: 10.1111/bcp.14982. Epub 2021 Aug 2.

Authors

Anne Kathrine Bengaard^{1

2

3}, Esben Iversen^{1

4}, Thomas Kallemose¹, Helle Gybel Juul-Larsen¹, Line Jee Hartmann Rasmussen^{1

5}, Kim Peder Dalhoff^{3

6}, Ove Andersen^{1

3

7}, Jesper Eugen-Olsen¹, Morten Baltzer Houlind^{1

2

8}

Affiliations

¹ Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.
² The Capital Region Pharmacy, Herlev, Denmark.
³ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁴ Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁵ Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA.
⁶ Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
⁷ Emergency Department, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.
⁸ Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.

PMID: 34242432
DOI: 10.1111/bcp.14982

Abstract

Aims: To investigate whether the association between levels of medication use (including polypharmacy and potentially inappropriate medications [PIMs]) and health outcomes such as readmission and mortality is dependent on baseline soluble urokinase plasminogen activator receptor (suPAR).

Methods: This registry-based cohort study included medical patients admitted to the emergency department at Copenhagen University Hospital Hvidovre, Denmark. Patients were grouped according to their admission suPAR levels: low (0-3 ng/mL), intermediate (3-6 ng/mL), or high (>6 ng/mL). Hyper-polypharmacy was defined as ≥10 prescribed medications. PIMs were identified based on the EU(7)-PIM list, and data on admissions and mortality were obtained from national registries. Risk of 90-day readmission and mortality was assessed by Cox regression analysis adjusted for sex, age and Charlson comorbidity index. Results were reported as hazard ratios within 90 days of index discharge.

Results: In total, 26 291 patients (median age 57.3 y; 52.7% female) were included. Risk of 90-day readmission and mortality increased significantly for patients with higher suPAR or higher number of medications. Among patients with low suPAR, patients with ≥10 prescribed medications had a hazard ratio of 2.41 (95% confidence interval = 2.09-2.78) for 90-day readmission and 8.46 (95% confidence interval = 2.53-28.28) for 90-day mortality compared to patients with 0 medications. Patients with high suPAR generally had high risk of readmission and mortality, and the impact of medication use was less pronounced in this group. Similar, but weaker, association patterns were observed between suPAR and PIMs.

Conclusion: The association between levels of medication use and health outcomes is dependent on baseline suPAR.

Keywords: acute care; biomarker; clinical pharmacy; emergency department; geriatric; medication errors; medication review; older; polypharmacy; potentially inappropriate medication; soluble urokinase plasminogen activator receptor.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomarkers
Cohort Studies
Emergency Service, Hospital
Female
Humans
Male
Medication Review*
Middle Aged
Prognosis
Receptors, Urokinase Plasminogen Activator*

Substances

Biomarkers
Receptors, Urokinase Plasminogen Activator