Soluble Urokinase Plasminogen Activator Receptor (suPAR) in the Emergency Department (Ed): A Tool for the Assessment of Elderly Patients

Abstract

Emergency department (ED) overcrowding is a global issue setting challenges to all care providers. Elderly patients are frequent visitors of the ED and their risk stratification is demanding due to insufficient assessment methods. A prospective cohort study was conducted to determine the risk-predicting value of a prognostic biomarker, soluble urokinase plasminogen activator receptor (suPAR), in the ED, concentrating on elderly patients. SuPAR levels were determined as part of standard blood sampling of 1858 ED patients. The outcomes were assessed in the group of <75 years (=younger) and ≥75 years (=elderly). The elderly had higher median suPAR levels than the younger (5.4 ng/mL vs. 3.7 ng/mL, p < 0.001). Increasing suPAR levels were associated with higher probability for 30-day mortality and hospital admission in all age groups. SuPAR also predicted 30-day mortality when adjusted to other clinical factors. SuPAR acts successfully as a nonspecific risk predictor for 30-day mortality, independently and with other risk-assessment tools. Low suPAR levels predict positive outcomes and could be used in the discharging process. A cut-off value of 4 ng/mL could be used for all ED patients, 5 ng/mL being a potential alternative in elderly patients.

Role of soluble urokinase type plasminogen activator receptor (suPAR) in predicting mortality, readmission, length of stay and discharge in emergency patients: A systematic review and meta analysis

“…The pooled analysis revealed a significant association between patients with high suPAR levels and length of hospital stay as compared to patients with low suPAR levels. It showed that patients with high suPAR levels stayed for a greater duration in the hospital as compared to patients with low suPAR levels (WMD = 2.82 days; 95% CI = 1.46-4.19; P < .0001; I 2 = 100%) as shown [21] Prospective Cohort Two Finnish hospital regions (Helsinki and Mikkeli) -High = >6 Low = <3 Holstein et al 2022 [32] Comparative Holstein et al 2022 [32] 330 in Supplementary Figure S5, http://links.lww.com/MD/K601. The exclusion of 1 study [21] was done to perform sensitivity analysis, however, it did not lead to a significant change in the heterogeneity of the included studies (Fig.…”

“…After a full-text assessment of 43 articles for their eligibility, 30 articles were excluded which didn't meet the inclusion criteria. As a result, 13 studies [19,21,23,[27][28][29][30][31][32][33][34][35][36] were finalized to be included in this meta-analysis. A summary of the literature search is presented in Figure 1.…”

“…Study and patients' baseline characteristics have been summarized in Tables 1 and 2 respectively. Out of all 13 included studies, 12 are observational studies [19,21,23,[27][28][29][30][31][32][33]35,36] and 1 is post hoc analysis of a multicenter study. [34] Included studies were published between July 2012 till June 2022.…”

“…[17,18] Several observational studies and clinical trials have been conducted to evaluate the role of suPAR in ED outcomes. [19][20][21][22][23] However, there is no pooled result and quantitative synthesis has not been conducted till date. Herein, we conducted a meta-analysis to explore the available data regarding ED outcomes of 30-day mortality, 90-day mortality, readmission within 30 days, discharge within 24 hours, and length of hospital stay (LOS) to draw conclusive results and determine the clinical role of suPAR, as an evolving biomarker, in the prognosis of patients in the emergency setting and its influence on risk stratification.…”

Value of the soluble urokinase-type plasminogen activator receptor as a predictor of prognosis in patients attended in hospital emergency departments

“…Un valor de suPAR > 6 ng/mL se asoció de manera independiente con mortalidad a 90 días y con mayor probabilidad de ingreso y de reconsulta, de forma similar a lo publicado por Holstein et al 22 , donde los pacientes con esos niveles tenían una mayor mortalidad. Esto apoyaría la hipótesis que este biomarcador aporta información pronóstica en los pacientes atendidos en urgencias, independientemente del país de pertenencia, y añade valor a otros aspectos que se usan de forma habitual.…”