Availability of suPAR in emergency departments may improve risk stratification: a secondary analysis of the TRIAGE III trial

Abstract

Introduction Soluble urokinase plasminogen activator receptor (suPAR) is a prognostic and nonspecific biomarker associated with short-term mortality in emergency department (ED) patients. Therefore, the blood level of suPAR might be usable for identification of patients at high- and low risk, shortly after arrival at the ED. Here, we investigate the value of adding suPAR to triage and how this may impact on risk stratification regarding mortality. Methods The analyses were performed on the TRIAGE III cohort. Patients were triaged in four groups: Red, Orange, Yellow, and Green. Outcome was all-cause mortality within seven days. Discriminative abilities of triage and suPAR on mortality were assessed using the area under the curve (AUC) for receiver operating characteristics (ROC) curves. A suPAR cut-off value was generated using the Youden’s index. Patients were subsequently reclassified one triage level up if the suPAR level was above this cut-off and one level down if the suPAR level was below that value. Results The study included 4420 patients with an available triage category and suPAR measurement. suPAR was significantly better in predicting mortality than triage; AUC (95% confidence interval): 0.85 (0.80–0.89) vs. 0.71 (0.64–0.78), P < 0.001. Combining suPAR and triage yielded an AUC of 0.87 (0.82–0-93). The Youden’s cut-off of suPAR was 5.9 ng/mL and reclassified triage using this value resulted in a more accurate risk stratification regarding hospital admission and mortality. Conclusion Addition of suPAR to triage potentially improves prediction of short-term mortality. Measurement of suPAR in relation to the triage process may allow a more accurate identification of ED patients at risk. Trial registration Clinicaltrials.gov , NCT02643459. Registered 31 December 2015. https://clinicaltrials.gov/ct2/show/NCT02643459?cond=NCT02643459&rank=1 . Electronic supplementary material The online version of this article (10.1186/s13049-019-0621-7) contains supplementary material, which is available to authorized users.

Admission levels of Soluble Urokinase Plasminogen Activator Receptor (suPAR) are Associated with the Development of Severe Complications in Hospitalised COVID-19 Patients: A Prospective Cohort Study

“…They were also found to be immune mediators for developing acute and chronic kidney disease, and more recently predictive of in-hospital acute kidney injury and the need for dialysis in COVID-19 hospitalised patients ( Azam et al, 2020 , Hayek et al, 2020 , Hayek et al, 2015 ). A potential role for suPAR in triaging patients attending emergency departments has been highlighted ( Schultz et al, 2019 , Uusitalo-Seppälä et al, 2012 ). It is essential to emphasise that suPAR levels do not only reflect underlying infections but are also influenced by pre-existing comorbidities like diabetes mellitus, chronic inflammation and others.…”

<p>High suPAR and Low Blood Eosinophil Count are Risk Factors for Hospital Readmission and Mortality in Patients with COPD</p>

“…A recent study showed that suPAR outperformed standard emergency triage in predicting mortality in ED patients, and the combination of triage and suPAR >5.7 ng/L (equivalent to the fourth suPAR quartile in the present study) yielded an AUC of 0.87 (0.82-0.93). 32 This suggests that suPAR indeed is a viable clinical marker for all-cause mortality in acutely admitted patients with COPD.…”

Soluble urokinase plasminogen activator receptor and lactate as prognostic biomarkers in patients presenting with non-specific chief complaints in the pre-hospital setting – the PRIUS-study

“…Positive and negative likelihood ratios as well as positive predictive values (PPV) and negative predictive values (NPV) were calculated from 2 × 2 contingency tables (crosstabulation) based on the diagnostic test and the outcome for the biomarkers. Before analysis cut-off, values for suPAR were defined as ≥3, ≥6, and ≥ 9 ng/ml based on [ 32 , 33 ] The cut-off for lactate was defined as ≥2.3 mmol/l based on the reference standard from Karolinska University Laboratory in Stockholm, Sweden. All statistical analysis was performed using IBM SPSS Statistics for Windows, version 25 (IBM Corp. Armonk, New York, USA).…”