Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III)

Schultz, Martin; Rasmussen, Line Jee Hartmann; Andersen, Malene Højgaard; Stefansson, Jakob S.; Falkentoft, Alexander Christian; Alstrup, Morten; Sandø, Andreas; Holle, Sarah Louise Kjølhede; Meyer, Jeppe; Törnkvist, Peter B. S.; Høi-Hansen, Thomas; Kjøller, Erik; Jensen, Birgitte Nybo; Lind, Morten; Ravn, Lisbet; Kallemose, Thomas; Lange, Theis; Køber, Lars; Rasmussen, Lars S.; Eugen‐Olsen, Jesper; Iversen, Kasper

doi:10.1186/s13049-018-0539-5

Cited by 24 publications

(32 citation statements)

References 35 publications

(38 reference statements)

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“…Our study cohort had notably lower median suPAR (2.7 ng/mL) than what has been reported by similar studies in the emergency department, such as the 2016 TRIAGE III trial in Denmark that reported median suPAR of 4.1 ng/mL (Schultz et al, 2018). This can be explained in part by our selection criteria.…”

Section: Discussioncontrasting

confidence: 52%

Elevated suPAR Is an Independent Risk Marker for Incident Kidney Disease in Acute Medical Patients

Iversen

Houlind

Kallemose

et al. 2020

Front. Cell Dev. Biol.

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Introduction: Identifying patients at high risk of developing kidney disease could lead to early clinical interventions that prevent or slow disease progression. Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker thought to be involved in the pathogenesis and development of kidney disease. We aimed to determine whether elevated plasma suPAR measured at hospital admission is associated with incident kidney disease in patients presenting to the emergency department.

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Section: Discussioncontrasting

confidence: 52%

Elevated suPAR Is an Independent Risk Marker for Incident Kidney Disease in Acute Medical Patients

Iversen

Houlind

Kallemose

et al. 2020

Front. Cell Dev. Biol.

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“…Only few randomised studies have investigated the value of adding suPAR as a prognostic biomarker to inform clinical practice, 74 75 and most evidence is based on observational studies of suPAR, but many studies have reported an association between suPAR and mortality. Summarising this evidence is important to establish the prognostic role of suPAR.…”

Section: Discussionmentioning

confidence: 99%

Soluble urokinase plasminogen activator receptor (suPAR) as a prognostic marker of mortality in healthy, general and patient populations: protocol for a systematic review and meta-analysis

et al. 2020

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IntroductionChronic inflammation is increasingly recognised as a major contributor to disease, disability and ultimately death, but measuring the levels of chronic inflammation remains non-canonised, making it difficult to relate chronic inflammation and mortality. Soluble urokinase plasminogen activator receptor (suPAR), an emerging biomarker of chronic inflammation, has been proposed as a prognostic biomarker associated with future incidence of chronic disease and mortality in general as well as patient populations. Proper prognostic biomarkers are important as they can help improve risk stratification in clinical settings and provide guidance in treatment or lifestyle decisions as well as in the design of randomised trials. Here, we wish to summarise the evidence about the overall association of the biomarker suPAR with mortality in healthy, general and patient populations across diseases.Methods and analysisThe search will be conducted using Medline, Embase and Scopus databases from their inception to 03 June 2020 to identify studies investigating ‘suPAR’ and ‘mortality’. Observational studies and control groups from intervention studies written in English or Danish will be included. The ‘Quality In Prognosis Studies’ tool will be used to assess the risk of bias for the studies included. Unadjusted and adjusted mortality outcome measures (eg, risk ratios, ORs, HRs) with 95% CIs will be extracted for healthy individuals, general and patient populations. The primary outcome is all-cause mortality within any given follow-up. Subgroup analyses will be performed based on time of outcome, cause of death, population type, adjustments for conventional risk factors and inflammation markers.Ethics and disseminationThis systematic review will synthesise evidence on the use of suPAR as a prognostic marker for mortality. The results will be disseminated by publication in a peer-reviewed journal. Data used will be obtained from published studies, and ethics approval is therefore not necessary for this systematic review.Trial registration number PROSPEROCRD42020167401.

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“…In the current study, we included patients’ first ED visit where both the suPAR level was determined and a triage category was recorded. The protocol and primary results have been published [10, 11].…”

Section: Methodsmentioning

confidence: 99%

Availability of suPAR in emergency departments may improve risk stratification: a secondary analysis of the TRIAGE III trial

Rasmussen

Kallemose

Kjøller

et al. 2019

Scand J Trauma Resusc Emerg Med

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Introduction Soluble urokinase plasminogen activator receptor (suPAR) is a prognostic and nonspecific biomarker associated with short-term mortality in emergency department (ED) patients. Therefore, the blood level of suPAR might be usable for identification of patients at high- and low risk, shortly after arrival at the ED. Here, we investigate the value of adding suPAR to triage and how this may impact on risk stratification regarding mortality. Methods The analyses were performed on the TRIAGE III cohort. Patients were triaged in four groups: Red, Orange, Yellow, and Green. Outcome was all-cause mortality within seven days. Discriminative abilities of triage and suPAR on mortality were assessed using the area under the curve (AUC) for receiver operating characteristics (ROC) curves. A suPAR cut-off value was generated using the Youden’s index. Patients were subsequently reclassified one triage level up if the suPAR level was above this cut-off and one level down if the suPAR level was below that value. Results The study included 4420 patients with an available triage category and suPAR measurement. suPAR was significantly better in predicting mortality than triage; AUC (95% confidence interval): 0.85 (0.80–0.89) vs. 0.71 (0.64–0.78), P < 0.001. Combining suPAR and triage yielded an AUC of 0.87 (0.82–0-93). The Youden’s cut-off of suPAR was 5.9 ng/mL and reclassified triage using this value resulted in a more accurate risk stratification regarding hospital admission and mortality. Conclusion Addition of suPAR to triage potentially improves prediction of short-term mortality. Measurement of suPAR in relation to the triage process may allow a more accurate identification of ED patients at risk. Trial registration Clinicaltrials.gov , NCT02643459. Registered 31 December 2015. https://clinicaltrials.gov/ct2/show/NCT02643459?cond=NCT02643459&rank=1 . Electronic supplementary material The online version of this article (10.1186/s13049-019-0621-7) contains supplementary material, which is available to authorized users.

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Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III)

Cited by 24 publications

References 35 publications

Elevated suPAR Is an Independent Risk Marker for Incident Kidney Disease in Acute Medical Patients

Elevated suPAR Is an Independent Risk Marker for Incident Kidney Disease in Acute Medical Patients

Soluble urokinase plasminogen activator receptor (suPAR) as a prognostic marker of mortality in healthy, general and patient populations: protocol for a systematic review and meta-analysis

Availability of suPAR in emergency departments may improve risk stratification: a secondary analysis of the TRIAGE III trial

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