Risk assessment in sepsis: a new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor

Abstract

IntroductionEarly risk assessment is the mainstay of management of patients with sepsis. APACHE II is the gold standard prognostic stratification system. A prediction rule that aimed to improve prognostication by APACHE II with the application of serum suPAR (soluble urokinase plasminogen activator receptor) is developed.MethodsA prospective study cohort enrolled 1914 patients with sepsis including 62.2% with sepsis and 37.8% with severe sepsis/septic shock. Serum suPAR was measured in samples drawn after diagnosis by an enzyme-immunoabsorbent assay; in 367 patients sequential measurements were performed. After ROC analysis and multivariate logistic regression analysis a prediction rule for risk was developed. The rule was validated in a double-blind fashion by an independent confirmation cohort of 196 sepsis patients, predominantly severe sepsis/septic shock patients, from Sweden.ResultsSerum suPAR remained stable within survivors and non-survivors for 10 days. Regression analysis showed that APACHE II ≥17 and suPAR ≥12 ng/ml were independently associated with unfavorable outcome. Four strata of risk were identified: i) APACHE II <17 and suPAR <12 ng/ml with mortality 5.5%; ii) APACHE II < 17 and suPAR ≥12 ng/ml with mortality 17.4%; iii) APACHE II ≥ 17 and suPAR <12 ng/ml with mortality 37.4%; and iv) APACHE II ≥17 and suPAR ≥12 ng/ml with mortality 51.7%. This prediction rule was confirmed by the Swedish cohort.ConclusionsA novel prediction rule with four levels of risk in sepsis based on APACHE II score and serum suPAR is proposed. Prognostication by this rule is confirmed by an independent cohort.

Serum soluble urokinase-type plasminogen activator receptor as a biological marker of bacterial infection in adults: a systematic review and meta-analysis

“…Among the 17 eligible studies, 9 studies including 1237 patients reported the usefulness of suPAR for diagnosing infections131415161718192021, and 10 studies including 3041 patients reported its usefulness for predicting mortality14212223242526272829. The characteristics of the studies are presented in Table S1.…”

“…Additionally, 4 studies investigated the diagnostic value of suPAR in differentiating sepsis from SIRS16192021. Of the 10 studies reporting the value of suPAR in predicting mortality, 7 recruited patients suffering from sepsis14212526272829, and 3 recruited patients with bacteremia222324. The serum level of suPAR was measured using an enzyme-linked immunosorbent assay kit (ViroGates, Birkerød, Denmark) in most of the included studies.…”

“…The pooled sensitivity and specificity of suPAR for mortality prediction in adult patients with bacteremia and sepsis were 0.70 and 0.72, respectively, which were similar to those of sTREM-1. The largest review, which included cohort studies enrolling a total of 1914 patients, suggested that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score combined with the serum suPAR level could be a novel rule for predicting the outcome of in sepsis26. Therefore, the combination of suPAR and other biological markers or risk scores can improve the prediction of mortality for infections.…”

Recurrent Primary Focal Segmental Glomerulosclerosis Managed With Intensified Plasma Exchange and Concomitant Monitoring of Soluble Urokinase-Type Plasminogen Activator Receptor–Mediated Podocyte β3-integrin Activation

“…It is known that total suPAR levels correlate with CRP levels in conditions of inflammation. 32 Systemic inflammation and/or change in renal function as potential confounders can be excluded in our study as median CRP levels remained low and baseline-creatinine did not change significantly during the full course of treatment.…”

Rapid diagnosis of sepsis

“…In a study on 454 critically patients receiving ventilatory support showed that suPAR levels were slightly higher in patients that died or developed acute kidney failure 87 . In another large study with 1914 patients with sepsis, suPAR levels >12 ng/ml were associated with an unfavorable outcome, especially in patients with an APACHE II score >17 88 . suPAR does not, as yet, have a role as a biomarker for sepsis diagnosis.…”