Elevated suPAR Is an Independent Risk Marker for Incident Kidney Disease in Acute Medical Patients

Iversen, Esben; Houlind, Morten Baltzer; Kallemose, Thomas; Rasmussen, Line Jee Hartmann; Hornum, Mads; Feldt‐Rasmussen, Bo; Hayek, Salim S.; Andersen, Ove; Eugen‐Olsen, Jesper

doi:10.3389/fcell.2020.00339

Cited by 17 publications

(25 citation statements)

References 42 publications

(50 reference statements)

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“…Patients with AKI exhibited significantly higher median plasma levels of suPAR and NGAL compared to patients without AKI ( Figure 1 ). Plasma suPAR and NGAL levels were also inversely correlated with baseline eGFR ( Figure A1 ), which supports previous literature demonstrating the connection between these biomarkers and kidney function [ 25 , 27 , 29 ]. The associations with suPAR may indicate the role of suPAR in systemic inflammation, which is expected to be elevated in our study group.…”

Section: Discussionsupporting

confidence: 89%

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Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department

et al. 2021

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Diagnosis of acute kidney injury (AKI) based on plasma creatinine often lags behind actual changes in renal function. Here, we investigated early detection of AKI using the plasma soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-sssociated lipocalin (NGAL) and observed the impact of early detection on prescribing recommendations for renally-eliminated medications. This study is a secondary analysis of data from the DISABLMENT cohort on acutely admitted older (≥65 years) medical patients (n = 339). Presence of AKI according to kidney disease: improving global outcomes (KDIGO) criteria was identified from inclusion to 48 h after inclusion. Discriminatory power of suPAR and NGAL was determined by receiver-operating characteristic (ROC). Selected medications that are contraindicated in AKI were identified in Renbase®. A total of 33 (9.7%) patients developed AKI. Discriminatory power for suPAR and NGAL was 0.69 and 0.78, respectively, at a cutoff of 4.26 ng/mL and 139.5 ng/mL, respectively. The interaction of suPAR and NGAL yielded a discriminatory power of 0.80, which was significantly higher than for suPAR alone (p = 0.0059). Among patients with AKI, 22 (60.6%) used at least one medication that should be avoided in AKI. Overall, suPAR and NGAL levels were independently associated with incident AKI and their combination yielded excellent discriminatory power for risk determination of AKI.

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Section: Discussionsupporting

confidence: 89%

“…Previous studies have suggested the systemic inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) as an early biomarker for detection of AKI [ 25 , 26 , 27 , 28 , 29 ]. suPAR is a signaling glycoprotein thought to be involved in kidney disease pathogenesis [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department

et al. 2021

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“…Furthermore, we require more knowledge about which patients have the best effect of medication deprescribing in relation to readmission and mortality. Recent literature has shown that the use of soluble urokinase-type plasminogen activator receptor (suPAR), as a non-specific inflammatory marker is strongly associated with disease burden, disease progression, readmission, and mortality [ 38 , 39 , 40 , 41 , 42 ]. It would be of high scientific value to investigate the effect of a deprescribing intervention in patients with low, intermediate or high suPAR levels.…”

Section: Discussionmentioning

confidence: 99%

A Collaborative Deprescribing Intervention in a Subacute Medical Outpatient Clinic: A Pilot Randomized Controlled Trial

et al. 2021

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Medication deprescribing is essential to prevent inappropriate medication use in multimorbid patients. However, experience of deprescribing in Danish Subacute Medical Outpatient Clinics (SMOCs) is limited. The objective of our pilot study was to evaluate the feasibility and sustainability of a collaborative deprescribing intervention by a pharmacist and a physician to multimorbid patients in a SMOC. A randomized controlled pilot study was conducted, with phone follow-up at 30 and 365+ days. A senior pharmacist performed a systematic deprescribing intervention using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, the Danish deprescribing list, and patient interviews. A senior physician received the proposed recommendations and decided which should be implemented. The main outcome was the number of patients having ≥1 medication where deprescribing status was sustained 30 days after inclusion. Out of 76 eligible patients, 72 (95%) were included and 67 (93%) completed the study (57% male; mean age 73 years; mean number of 10 prescribed medications). Nineteen patients (56%) in the intervention group and four (12%) in the control group had ≥1 medication where deprescribing status was sustained 30 days after inclusion (p = 0.015). In total, 37 medications were deprescribed in the intervention group and five in the control group. At 365+ days after inclusion, 97% and 100% of the deprescribed medications were sustained in the intervention and control groups, respectively. The three most frequently deprescribed medication groups were analgesics, cardiovascular, and gastrointestinal medications. In conclusion, a collaborative deprescribing intervention for multimorbid patients was feasible and resulted in sustainable deprescribing of medication in a SMOC.

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“…It has previously shown that low suPAR is associated with low risk of adverse outcomes for acute medical patients, such as acute kidney injury (12,13 ), acute surgery ( 14), and overall mortality (10). These studies were mainly retrospective biobanked studies using ELISA platform for measurement of suPAR in batches, which demands manual work and has high processing time.…”

Section: Discussionmentioning

confidence: 99%

suPAR Cut-offs for Stratification of Low, Medium, and High-risk Acute Medical Patients in the Emergency Department

Seppälä

Andersen

Nyyssönen

et al. 2021

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Background: Soluble urokinase plasminogen activator receptor (suPAR) levels have previously been associated with readmission and mortality in acute medical patients in the ED. However, no specific cut-offs for suPAR has been tested in this population. Methods: Prospective observational study of acute medical patients. Follow-up of mortality and readmission was carried out for 30- and 90 days stratified into baseline suPAR < 4, 4-6 and > 6 ng/ml. suPAR levels were measured using suPARnostic® Turbilatex assay on a Cobas c501 (Roche Diagnostics Ltd) analyser. Results: A total of 1747 acute medical patients in the ED were included. Median age was 70 (IQR: 57-79) and 51.4% were men. Cox regression analysis showed that suPAR, independently of age, sex and C-reactive protein levels, predicted 30- and 90-day mortality (both p<0.001). Among patients with suPAR below 4 ng/ml (N=804, 46.0%), 8 (1.0%) died within 90-day follow-up, resulting in a negative predictive value of 99.0% and a sensitivity of 94.6%. Altogether 514 (29.4%) patients had suPAR4-6 ng/ml, of whom 43 (8.4%) died during 90-day follow-up. Among patients with suPAR above 6 ng/ml (N=429, 24.6%), 87 patients (20.3%) died within 90-day follow-up, resulting in a positive predictive value of 20.1% and a specificity of 78.7%. Conclusions: suPAR cut-offs of below 4, between 4-6 and above 6 ng/ml can identify acute medical patients who have low, medium or high risk of 30- and 90-day mortality. The turbidimetric assay provides fast suPAR results that may aid in the decision of discharge or admission of acute medical patients.

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Elevated suPAR Is an Independent Risk Marker for Incident Kidney Disease in Acute Medical Patients

Cited by 17 publications

References 42 publications

Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department

Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department

A Collaborative Deprescribing Intervention in a Subacute Medical Outpatient Clinic: A Pilot Randomized Controlled Trial

suPAR Cut-offs for Stratification of Low, Medium, and High-risk Acute Medical Patients in the Emergency Department

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