Clinical scores and blood biomarkers for early risk assessment of patients presenting to the emergency department – Critical review

The use of an accurate and well-validated triage system in the emergency department is pivotal for early risk stratification of medical patients. For this purpose different clinical scores, such as the Manchester Triage Score, are widely propagated. Prognostic blood biomarkers mirroring physiopathological changes in different organ systems and severity of disease provide additional prognostic information. Also, nursing scores have been developed for early prediction of post-acute care needs. Still, there is no well-validated initial triage score integrating this information on clinical status, biomarker, prognosis and nursing care needs for a more overall assessment of patients. Such an integral score will help to estimate early initial treatment priority, decide site of care and predict post-acute care needs, and thereby optimise management of undifferentiated patients. The aim of this current review is to critically summarise potential and limitations of present clinical risk scores and blood biomarkers that have been used in recent studies in the emergency department setting for early patient assessment. Particularly, we focused on the following biomarkers from different organ systems: proadrenomedullin, C-reactive protein and procalcitonin as markers of infection/vasodilation; high-sensitivity troponin T assay and natriuretic peptides as cardiac dysfunction markers; copeptin and cortisol as markers of stress; plasma neutrophil gelatinase-associated lipocalin, the soluble form of urokinase-type plasminogen activator and urea as markers of kidney dysfunction; thyroid hormones and proEndothelin-1 as a marker of endothelial activation and lactate as a marker of organ dysfunction. Despite the promising role of clinical scores and biomarkers from different pathophysiological concepts, no conclusive clinical trial has yet looked at different biomarkers in a large and comprehensive patient population. In addition, it remains unclear whether the use of scores and biomarkers has the potential to improve clinical outcome of patients as randomised trials are largely lacking.