Abstract
BackgroundSoluble 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.MethodsProspective 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.ResultsA 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%.ConclusionssuPAR 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.
Highlights
Soluble urokinase plasminogen activator receptor levels have previously been associated with readmission and mortality in acute medical patients in the Emergency Department (ED)
Patients that presented with comorbidities (Diabetes 1 or 2 (DM), cardiovascular disease (CVD), neurological disease (NEU) or pulmonary disease (PULM) had generally elevated Soluble urokinase plasminogen activator receptor (suPAR) levels (Table 1)
This study shows that suPAR, measured using a fully automated turbidimetric assay, provides prognostic patient value
Summary
Soluble urokinase plasminogen activator receptor (suPAR) levels have previously been associated with readmission and mortality in acute medical patients in the ED. There is an opportunity for improving triage by including knowledge of patient prognosis This could lead to more low risk patients being early and safely discharged, thereby reducing patient crowding, and to Santeri et al BMC Emergency Medicine (2021) 21:149 avoidance of premature discharge of high-risk patients [1, 2]. There are several reasons why soluble urokinase plasminogen activator receptor (suPAR) is a suitable attention biomarker in unselected acute medical patients: First, suPAR is a non-specific marker elevated by diseases in general and by the severity of disease. SuPAR is a stable marker and the measurement is unaffected by diurnal changes [7], and thirdly, suPAR has recently become easy to measure using automated turbidimetric analysis providing fast answers on overall patient prognosis [8]
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