Utilization of Prognostic Biomarker Soluble Urokinase Plasminogen Activator Receptor in the Emergency Department: A Tool for Safe and More Efficient Decision-making

Abstract

Introduction: Risk stratification in the emergency departments (EDs) is in critical need for new applications due to ED overcrowding and hospitalization of older people. We aimed to evaluate the expediency, efficiency and safety of a prognostic biomarker, soluble urokinase plasminogen activator receptor (suPAR), as a tool for the risk assessment of patients arriving at the ED. Methods: We performed a comparative cross-sectional study in 2 emergency departments (EDs), suPAR measurements being incorporated into routine blood sampling in the intervention ED. The primary outcome was the number of discharges from the ED. The importance of the outcomes was examined by appropriate multi- or bivariate analysis. Results: The absolute and relative number of discharges were similar between the intervention and control groups [121 (55.3%) vs 62 (55.9%)]. No significant differences between the groups were seen in the length of stays in the ED. Patients with low suPAR values were more likely discharged and patients with high suPAR values more likely admitted to hospital. Two admitted patients with low suPAR values could have been discharged safely. Conclusion: The utilization of suPAR did not increase the risk for neither positive nor negative outcomes. Low suPAR values could be potential in discharging more patients safely. Instead of unselected patient populations, the benefits of suPAR measurements in the ED could emerge in the assessment of a more precisely determined and selected group of 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

“…Data on discharge within 24 hours from the hospital were reported by 5 observational studies. [ 19 , 21 , 23 , 31 , 32 ] This revealed a positive correlation between patients with high suPAR levels and discharge from the hospital within 24 hours (RR = 0.42; 95% CI = 0.32–0.56; P < .00001; I 2 = 80%) as shown in Supplementary Figure S4, http://links.lww.com/MD/K600 . Sensitivity analysis was carried out by removing 1 study, [ 19 ] this resulted in a very slight alteration in the risk (RR = 0.46; 95% CI = 0.40–0.53; P < .00001) and revealed mild heterogeneity (I 2 = 41%; P = .17) (Fig.…”

“…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.…”

Multimarkers approach in chest pain management in Emergency department: a focus on the prognostic role of sST2 and suPAR

“…In a clinical setting where diagnostic accuracy is crucial, the search for additional and complementary biomarkers to troponin reflects the growing need to improve the sensitivity and specificity of diagnoses. 5,6 cTN Cardiac troponin is one of the main biomarkers used in the assessment of cardiac damage. Its complex consists of the subunits troponin I (TnI), troponin T (TnT), and troponin C (TnC).…”