Prognostic Role of Soluble Urokinase Plasminogen Activator Receptor at the Emergency Department: A Position Paper by the Hellenic Sepsis Study Group

Velissaris, Dimitrios; Dimοpoulos, George; Parissis, John; Alexiou, Zoi; Antonakos, Nikolaos; Babalis, Dimitrios; Gerakari, Styliani; Kaldis, Vasileios; Koutoukas, Pantelis; Lada, Malvina; Leventogiannis, Konstantinos; Pantazopoulos, Ioannis; Παπαδοπουλοσ, Αντωνιοσ; Polyzogopoulou, Eftihia; Gogos, Charalambos; Armaganidis, Apostolos; Giamarellos‐Bourboulis, Evangelos J.

doi:10.1007/s40121-020-00301-w

Cited by 19 publications

(20 citation statements)

References 18 publications

(20 reference statements)

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“…[ 6 , 7 , 26 ] A recent position paper on suPAR in the ED suggests 4 ng/ml as a cut-off level for safe discharge. [27] However, this recommendation was based on a single study conducted before the SARS-CoV-2 pandemic, focusing primarily on mortality. [27] Our results suggest a lower cut-off value for safe discharge in patients with COVID-19 symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Soluble Urokinase Plasminogen Activator Receptor as a Decision Marker for Early Discharge of Patients with COVID-19 Symptoms in the Emergency Department

Stauning

Altintas

Kallemose

et al. 2021

The Journal of Emergency Medicine

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Background SARS-CoV-2 strains healthcare capacity. Better risk stratification, with discharge of patients with a predicted mild disease trajectory can ease this burden. Elevated blood soluble urokinase plasminogen activator receptor (suPAR) has previously been shown associated with risk of intubation in confirmed COVID-19 patients. Objective To evaluate if point-of-care measures of suPAR in patients presenting at the emergency department (ED) with symptoms of COVID-19 can identify patients that can be safely discharged. Methods Observational cohort study including all patients in the ED with symptoms of COVID-19 from March 19 th to April 3 rd , 2020. Soluble urokinase plasminogen activator receptor was measured at first presentation. Review of electronic patient records 14 days after admission were used to assess disease trajectory. Primary endpoints were mild, moderate, severe, or very severe trajectory. The predictive value of suPAR, National early warning score (NEWS), C-reactive protein (CRP), and duration of symptoms (DOS) was calculated using receiver operating characteristics (ROC). Results Of 386 patients, 171 (44%) patients had a mild disease trajectory, 79 (20%) a moderate, 63 (16%) a severe, and 73 (19%) a very severe disease trajectory. Low suPAR was a strong marker of mild disease trajectory. Results suggest a cut-off for discharge for suPAR<2.0 ng/ml if suPAR is used as a single parameter, and 3.0 ng/ml when combined with NEWS=<4 and CRP<10 mg/l- Conclusion suPAR is a potential biomarker for triage and safe early discharge of patients with COVID-19 symptoms in the ED. suPAR can be used even before SARS-CoV-2 status is known.

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Section: Discussionmentioning

confidence: 99%

“… [27] However, this recommendation was based on a single study conducted before the SARS-CoV-2 pandemic, focusing primarily on mortality. [27] Our results suggest a lower cut-off value for safe discharge in patients with COVID-19 symptoms. Few studies have been conducted on suPAR in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Soluble Urokinase Plasminogen Activator Receptor as a Decision Marker for Early Discharge of Patients with COVID-19 Symptoms in the Emergency Department

Stauning

Altintas

Kallemose

et al. 2021

The Journal of Emergency Medicine

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“…A recent position paper from the Hellenic Sepsis study group suggests suPAR below 4 ng/ml for discharge and above 6 ng/ml for further examination. 18 While suPAR above 6 ng/ml may be a good cut-off level indicating need for clinical attention and further examination, suPAR below 6 ng/ml may be too high for safe discharge. The Youden Index identified a suPAR cut-off of 4.75 ng/ml for respiratory failure in Obs-COVID-19 patients in the current study, in agreement with safe discharge after thorough clinical examination if the patient has a suPAR level below 4 ng/ml.…”

Section: Discussionmentioning

confidence: 99%

Low levels of the prognostic biomarker suPAR are predictive of mild outcome in patients with symptoms of COVID-19 - a prospective cohort study

Eugen‐Olsen

Altintas

Tingleff

et al. 2020

Preprint

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OBJECTIVE To examine if baseline soluble urokinase plasminogen activator receptor (suPAR) can predict whether patients with COVID-19 symptoms will need mechanical ventilation during a 14-day follow-up. Furthermore, to examine differences in demographics, clinical signs, and biomarkers in patients tested either positive or negative for SARS-CoV-2. DESIGN Prospective cohort study including patients presenting with symptoms of COVID-19. SETTING Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark. PARTICIPANTS 407 patients presenting with symptoms of COVID-19 were included from the Emergency Department (ED). Patients were included from March 19 to April 3 and follow-up data was collected until April 17, 2020. MAIN OUTCOME MEASURES Primary outcomes were respiratory failure in patients presenting with symptoms of COVID-19 and in those with a positive SARS-CoV-2 RT-PCR test, respectively. Furthermore, we analysed differences between patients testing positive and negative for SARS-CoV-2, and disease severity outcomes in SARS-CoV-2 positive patients according to baseline suPAR. BACKGROUND Patients admitted to ED with clinical signs or symptoms of COVID-19 infection need a safe and quick triage, in order to determine if an in-hospital stay is necessary or if the patient can safely be isolated in their own home with relevant precautions. suPAR is a biomarker previously shown to be associated with adverse outcomes in acute medical patients. We aimed to examine if suPAR at baseline presentation is predictive of respiratory failure in patients presenting with symptoms of COVID-19. Furthermore, we examined demographic, clinical, and biochemical differences between SARS-CoV-2-positive and negative patients. RESULTS Among the 407 symptomatic patients, the median (interquartile range) age was 64 years (47-77), 58% were women, and median suPAR was 4.2 ng/ml (2.7-6.4). suPAR level below 4.75 ng/ml at admission ruled out respiratory failure during follow-up with an area under the curve (95% CI) of 0.89 (0.85-0.94) and a negative predictive value of 99.5%. Of the 407 symptomatic patients, 117 (28.8%) had a positive RT-PCR test for SARS-CoV-2 and presented with significant differences in vital signs, cell counts, and biomarkers compared to SARS-CoV-2 negative patients. In SARS-CoV-2 positive patients eligible for mechanical ventilation (N=87), 26 (30%) developed respiratory failure. Best baseline predictors of respiratory failure were suPAR with an area under the curve (95% CI) of 0.88 (0.80-0.95), EWS 0.84 (0.75-0.93), lactate dehydrogenase 0.82 (0.71-0.93), and C-reactive protein 0.80 (0.70-0.89). CONCLUSION SARS-CoV-2 affects several patient parameters underpinning the severe impact of the infection. A low suPAR level (<4.75 ng/ml) at baseline is a useful biomarker for aiding clinical decisions including discharge of patients presenting with symptoms of COVID-19.

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“…Its long plasma half life of 7 - 10 days suggests that it is not readily degraded [ 1 , 2 ]. Noxious stimuli induce suPAR release by proteolysis, thus it was assumed that its concentration reflects underlying immune system activity [ 4 , 5 ]. It is measured by enzyme-linked immunosorbent assay (ELISA) in blood plasma samples.…”

Section: Introductionmentioning

confidence: 99%

“…In clinical studies various cut-off points have been used to denote different prognostic implications. For example, in the assessment of patients with suspected sepsis in the emergency department a cut-off value of 12 ng/mL has been used to identify patients with active sepsis at high risk for acute mortality, whereas a value greater than 6 ng/mL may be used to screen patients at high risk of mortality from non-infectious disease, once infection has been ruled out [ 5 ]. Plasma suPAR elevation is associated with systemic inflammatory response syndrome (SIRS), and it is also common in a wide variety of diseases, including cancer, diabetes type II, renal failure, cardiovascular disease and various infections [ 6 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

Soluble Urokinase Plasminogen Activator Receptor as a Diagnostic and Prognostic Biomarker in Cardiac Disease

et al. 2021

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This review summarizes the published literature referring to the use and validity of the biomarker soluble urokinase plasminogen activator receptor (suPAR) when used for the assessment of patients with cardiac diseases. It is measured by enzyme-linked immunosorbent assay (ELISA) in plasma samples. In cardiology a cutoff value range of 3.5-4.5 ng/mL has been commonly utilized. Different cutoff values may be applied based on the measuring kit used, the patient population and the clinical setting. A PubMed/Medline search was conducted aiming to identify all publications relevant to the use of suPAR in patients with cardiac diseases. A total of 39 studies were included in this review. suPAR as a marker of inflammation has been used more extensively in recent years, alone or in combination with other biomarkers of inflammation and cardiac pathology in the assessment of patients with acute and chronic cardiac diseases. suPAR is closely related to the pathophysiology of cardiac disease, and a number of publications encourages its use as a valuable biomarker in the assessment of patients presenting to the cardiology service. It may be most valuable in the risk assessment of patients with acute coronary syndromes and congestive heart failure, as suPAR elevation may be an independent predictor of mortality in these conditions. In conclusion, among several biomarkers used for clinical entities with underlying inflammatory pathophysiology including cardiac diseases, suPAR is a novel attractive index for the prognostic risk stratification of cardiac patients. More research is warranted to confirm its diagnostic and prognostic validity, alone or combined with other cardiac and inflammatory biomarkers.

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Prognostic Role of Soluble Urokinase Plasminogen Activator Receptor at the Emergency Department: A Position Paper by the Hellenic Sepsis Study Group

Cited by 19 publications

References 18 publications

Soluble Urokinase Plasminogen Activator Receptor as a Decision Marker for Early Discharge of Patients with COVID-19 Symptoms in the Emergency Department

Soluble Urokinase Plasminogen Activator Receptor as a Decision Marker for Early Discharge of Patients with COVID-19 Symptoms in the Emergency Department

Low levels of the prognostic biomarker suPAR are predictive of mild outcome in patients with symptoms of COVID-19 - a prospective cohort study

Soluble Urokinase Plasminogen Activator Receptor as a Diagnostic and Prognostic Biomarker in Cardiac Disease

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