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

Abstract

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.

suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19

“…However, transfer to facilities with isolation capacity but without the availability of mechanical ventilation should not only be based on a suPAR value alone, but also be carried out after thorough clinical examination and reviewing other relevant biomarkers such as CRP levels and NEWS, by ED physicians. 1 …”

“…The study is a single center observational cohort study at Department of Emergency Medicine, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark. 1 Patients included in the cohort were referred to the ED when primary sector-treatment due to COVID-19 symptoms and/or general health status was not feasible. Symptoms were mainly cough, fever, chest pain, arthralgia, shortness of breath, and headache.…”

“…The data collection is described in detail elsewhere. 1 In brief, we collected data on age, gender, number of comorbidities, national early warning score (NEWS), tobacco smoking habits, and duration of symptoms from electronic patient health records as well as blood biochemistry with the software Research Electronic Data Capture program (REDCap), and quality control of data was performed by 3 medical doctors (IA, MS, and JT). 1 …”

“…We have previously shown that soluble urokinase plasminogen activator receptor (suPAR) is a suitable biomarker to identify patients with COVID-19 symptoms who can be discharged from the Emergency Department (ED) at an early stage without risk of severe disease trajectory. 1 In the present study, we seek to examine suPAR as a possible decision tool that may guide physicians to allocate patients to facilities with and without access to mechanical ventilation.…”

Clinical Management of COVID-19 Patients – An Update

“…Fibrin d-dimer, coronary markers such as Troponin-I and ferritin may be considered in COVID-19 patients due to the risk of cardiovascular events and hyperinflammation. These markers have all been associated with disease progression, severity and outcome ( 16 , 17 ).…”