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Abstract
Background
Biomarkers may aid in risk triaging of systemic inflammatory response syndrome (SIRS)
patients at admittance to hospital and in the monitoring of response to medical intervention.
The overall aim is reducing mortality in SIRS and sepsis patients.
Methods
A prospectively collected cohort of patients with SIRS that were admitted to an emergency
department and a department of infectious diseases at a Copenhagen University hospital
were studied. Samples obtained daily during hospitalization were measured for soluble
urokinase plasminogen activator receptor (suPAR) using the CE/IVD-approved (the product
complies with the European Directives for In-Vitro Diagnostics) suPARnostic® assay
and were compared with various other clinical parameters associated with assessing
disease severity, including C-reactive protein, procalcitonin, Simplified Acute Physiology
Score II, and Sepsis-related Organ Failure Assessment scores. Survival was assessed
using receiver operating curve statistics.
Results
One hundred and fifty-one patients were included in the study, nine of whom died within
30 days of admission. Admission levels of suPAR were higher among non-survivors compared
to survivors with an area under the curve of 0.80 and 0.92 when combined with age.
Admission levels of procalcitonin and C-reactive protein were not significantly different
between survivors and nonsurvivors. Simplified Acute Physiology Score II and Sepsis-related
Organ Failure Assessment scores were significant predictors of death in this setting
as well. During treatment, survivors showed overall declining suPAR levels (Figure
1) while continuously elevated suPAR levels were observed in nonsurvivors (Figure
2).
Figure 1
suPAR levels among surviving SIRS patients during treatment. Dotted line, mean suPAR
among patients with an inclusion suPAR >5 ng/ml (n = 50). Dashed line, suPAR levels
among patients with an inclusion suPAR <5 ng/ml (n = 68).
Figure 2
suPAR levels among patients who either had severe complications (n = 14) or died (n
= 9) within 30 days of hospitalization. Dotted line, mean suPAR for the 23 patients.
Conclusion
The suPARnostic® assay provided significant information on risk of mortality following
admission. Continuous elevated suPAR levels during treatment were associated with
poor clinical outcome.