TY - JOUR

T1 - Using soluble urokinase plasminogen activator receptor to stratify patients for medication review in the emergency department

AU - Bengaard, Anne Kathrine

AU - Iversen, Esben

AU - Kallemose, Thomas

AU - Juul-Larsen, Helle Gybel

AU - Rasmussen, Line Jee Hartmann

AU - Dalhoff, Kim Peder

AU - Andersen, Ove

AU - Eugen-Olsen, Jesper

AU - Houlind, Morten Baltzer

N1 - Landmarks in Pharmacometrics/Key Methods in Modelling and Simulation

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

KW - acute care

KW - biomarker

KW - clinical pharmacy

KW - emergency department

KW - geriatric

KW - medication errors

KW - medication review

KW - older

KW - polypharmacy

KW - potentially inappropriate medication

KW - soluble urokinase plasminogen activator receptor

U2 - 10.1111/bcp.14982

DO - 10.1111/bcp.14982

M3 - Journal article

C2 - 34242432

AN - SCOPUS:85111670741

VL - 88

SP - 1679

EP - 1690

JO - British Journal of Clinical Pharmacology, Supplement

JF - British Journal of Clinical Pharmacology, Supplement

SN - 0264-3774

IS - 4

ER -