Predictors of hospitalization and early emergency department revisit in patients with pericardial syndromes: the PES-ED Study

Introduction

Pericardial syndromes account for approximately 5% of non-ischemic chest pain presentations in the Emergency Department (ED) [1-4]. Identification of factors associated with hospitalization and early revisit is relevant for clinical risk stratification.

Materials and Methods

We conducted a retrospective monocentric observational cohort study including all adult patients evaluated for pericardial syndromes in a tertiary-care ED between January 1, 2020 and April 30, 2024. Diagnosis was established according to ESC criteria. The primary endpoint were hospital admission and 30-day ED revisit.

Results

A total of 943 patients were included (mean age 59.8 ± 21.4 years; 53% male). Hospitalization occurred in 547 patients (58%), while 370 were discharged after ED evaluation. 26 died in ED.

Severe effusion (>20 mm) was more frequent in males (25.9% vs 15.8%, p=0.001). Pleural effusion was present in 32.7% of patients and was more common in females (35.3% vs 30.3%, p=0.037).

Compared with discharged patients, hospitalized individuals were older (63.8±20.5 vs 53.2±21.3 years, p=0.001) and more frequently male. They presented more frequently with dyspnea (43.9% vs 22.4%, p<0.001) and fever (33.3% vs 18.9%, p<0.001), whereas chest pain was more frequent among discharged patients (80.8% vs 45.3%, p<0.001). Moderate (10–20 mm) and severe (>20 mm) pericardial effusion were significantly more prevalent among admitted subjects (p<0.001).

Laboratory findings at admission showed higher white blood cell count (11.1±7.1 vs 9.2±3.6 ×10³/mm³, p<0.001), neutrophil count (8.4±4.3 vs 6.6±3.5 ×10³/mm³, p=0.002) and C-reactive protein (83.1±72.7 vs 50.4±49.2 mg/L, p<0.001) in hospitalized patients. Troponin T levels were significantly higher in admitted patients as were NT-proBNP values (p<0.001). Hospitalized patients also presented higher lactate levels (1.6±2.3 vs 0.9±0.6 mmol/L, p<0.001).

Colchicine was prescribed at ED evaluation in 31.1% of discharged patients and in 9.8% of hospitalized patients (p<0.001). In multivariate logistic regression analysis adjusted for age and sex, dyspnea, elevated CRP levels, and increasing pericardial effusion severity remained independently associated with hospitalization, whereas colchicine prescription at ED presentation was inversely associated with admission.

Thirty-day ED revisit occurred in 132 patients (14%). Revisit was more frequent in females (54.5% vs 45.1%, p=0.046), in patients presenting with chest pain at index visit (69.6% vs 57.4%, p=0.025), and in those with previous cardiac surgery (20.4% vs 10.5%, p=0.003). Colchicine prescription showed a significant trend toward lower revisit rates (12.1% vs 17.5%, p=0.04).

Conclusions

Hospitalization in patients with pericardial syndromes was associated with inflammatory burden, myocardial involvement markers, and pericardial effusion severity. Colchicine prescription at ED evaluation showed a trend toward reduced early revisit.