suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department

Abstract

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 have been tested in this population. Methods Prospective observational study of consecutively included 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. Adjusted linear regression analysis showed that suPAR, independently of age, sex and C-reactive protein levels, predicted 30- and 90-day mortality (Odds ratio for doubling in suPAR 1.96 (95% confidence intervals: 1.42–2.70) 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 suPAR of 4–6 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 and 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 suPAR results within 30 min that may aid in the decision of discharge or admission of acute medical patients.

Soluble urokinase plasminogen activator receptor and procalcitonin for risk stratification in patients with a suspected infection in the emergency department: a prospective cohort study

“…This is supported by our study, where we found an AUC of 0.72 of procalcitonin on 30-day mortality. suPAR showed the highest AUC on 30-day mortality in our study, which corresponds to other ED studies that investigated the predictive value of suPAR and also report AUCs between 0.80 and 0.84 [10,12].…”

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

“…As a previous study working with the same research data has concluded [ 27 ], this study confirms that suPAR has prognostic value in predicting both negative and positive outcomes: patients with increased suPAR levels are more likely to die within 30 days of index admission, and patients with low suPAR levels are more likely to be discharged from the ED and survive within 30 days of index admission, regardless of age. Vice versa, the suPAR levels among patients who died within 30 days were significantly higher than the levels of the discharged patients.…”

Association between variables measured in the ambulance and in-hospital mortality among adult patients with and without infection: a prospective cohort study

“…suPAR has been shown to be a prognostic marker in a wide range of conditions involving an inflammatory state, including sepsis and pneumonia but also myocardial infarction, chronic obstructive pulmonary disease (COPD), chronic kidney disease, diabetes, and cancer [ 19 , 24 – 30 ] and suPAR is measured routinely in some EDs in Denmark [ 31 ]. Levels < 4.0 have been considered as “low risk” among ED patients and support discharge from the ED [ 32 ], while levels > 6.0 ng/mL have been proposed to indicate a high risk for death [ 32 ]. The current results support that high levels of suPAR are associated with a poor outcome not only among patients with an infection.…”