scholarly journals suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19

2021 ◽  
Vol 16 ◽  
pp. 117727192110346
Author(s):  
Izzet Altintas ◽  
Jesper Eugen-Olsen ◽  
Santeri Seppälä ◽  
Jens Tingleff ◽  
Marius Ahm Stauning ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Predictive Value ◽  
Risk Groups ◽  
Adverse Outcomes ◽  
Central Hospital ◽  
Urokinase Plasminogen Activator Receptor ◽  
Risk Of Mortality ◽  
Observational Cohort ◽  
Plasminogen Activator Receptor

Objectives: Elevated soluble urokinase Plasminogen Activator Receptor (suPAR) is a biomarker associated with adverse outcomes. We aimed to investigate the associations between plasma suPAR levels (testing the cut-offs ⩽4, 4-6, and ⩾6 ng/mL) with risk of 14-day mortality, and with the risk of mechanical ventilation in patients that tested positive for SARS-CoV-2. Methods: Observational cohort study of patients presenting with symptoms of COVID-19 at Department of Emergency Medicine, Amager and Hvidovre Hospital, Denmark from March 19th, 2020 to April 3rd, 2020. Plasma suPAR was measured using suPARnostic technologies. Patients were followed for development of mechanical ventilation and mortality for 14 days. Validation of our findings were carried out in a similar sized COVID-19 patient cohort from Mikkeli Central Hospital, Finland. Results: Among 386 patients with symptoms of COVID-19, the median (interquartile range) age was 64 years (46-77), 57% were women, median suPAR was 4.0 ng/mL (2.7-5.9). In total, 35 patients (9.1%) died during the 14 days follow-up. Patients with suPAR ⩽4 ng/mL (N = 196; 50.8%) had a low risk of mortality (N = 2; 1.0%; negative predictive value of 99.0%, specificity 55.3%, sensitivity 95.2%, positive predictive value 17.4%). Among patients with suPAR ⩾6 ng/mL (N = 92; 23.8%), 16 died (17.4%). About 99 patients (25.6%) tested positive for SARS CoV-2 and of those 12 (12.1%) developed need for mechanical ventilation. None of the SARS-CoV-2 positive patients with suPAR ⩽4 ng/mL (N = 28; 38.8%) needed mechanical ventilation or died. The Mikkeli Central Hospital validation cohort confirmed our findings concerning suPAR cut-offs for risk of development of mechanical ventilation and mortality. Conclusions: Patients with symptoms of COVID-19 and suPAR ⩽4 or ⩾6 ng/mL had low or high risk, respectively, concerning the need for mechanical ventilation or mortality. We suggest cut-offs for identification of risk groups in patients presenting to the ED with symptoms of or confirmed COVID-19.

Abstract 14499: Impact of Pre-existing and New Incident Atrial Fibrillation on Outcomes of Patients With Acute Pulmonary Embolism: Findings From an International Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Behnood Bikdeli ◽  
David Jimenez ◽  
Jorg Del Toro ◽  
Gregory Piazza ◽  
Augussina Rivas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Acute Pulmonary Embolism ◽  
Adverse Outcomes ◽  
Risk Of Mortality ◽  
Patient Groups ◽  
The Impact ◽  
Related Mortality

Background: Atrial fibrillation (AF) may occur prior to or early in the course of acute pulmonary embolism (PE). The impact of AF on outcomes of patients with PE remains uncertain. Methods: Using the data from a large prospective multicenter registry of patients with objectively-confirmed PE (04/2014 to 01/2020), we identified three patient groups: 1) those with pre-existing AF 2) patients with newly identified AF within 2 days from the index PE (incident AF) and 3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, in unadjusted and multivariable adjusted models considering those without AF as referent. Results: Among 16,497 patients with PE, 792 had pre-existing AF. Compared with those without AF, patients with pre-existing AF, had increased odds of 90-day all-cause (Odds ratio [OR]: 2.81 (95% confidence interval [CI]: 2.33-3.38) and PE-related mortality (OR: 2.38, 95% CI: 1.37-4.14). After multivariable adjustment, pre-existing AF significantly increased the odds of all-cause mortality (OR: 1.91, 95% CI: 1.57-2.32) but not PE-related mortality (OR: 1.50; 95% CI: 0.85-2.66). Pre-existing AF was associated with increased hazard for ischemic stroke at 1-year follow-up (hazard ratio [HR]: 5.48; 95% CI: 3.10-9.69). Among 16,497 patients with PE, 445 developed incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR: 2.28; 95% CI: 1.75-2.97) and PE-related (OR: 3.64; 95% CI: 2.01-6.59) mortality. Findings were similar in multivariable analyses and at 1-year follow-up (Figure). No patients with incident AF developed ischemic stroke. Conclusion: In patients with acute symptomatic PE, both pre-existing AF and incident AF predict an adverse clinical course, although the type of adverse outcomes may be different depending on the timing of AF onset.

P1633Age, creatinine, and ejection fraction (ACEF) score continues to predictive prognosis in patients with ischemic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W Z Chen ◽  
P Ran ◽  
A P Cai
Keyword(s):  
Ejection Fraction ◽  
Predictive Value ◽  
Ischemic Cardiomyopathy ◽  
Malignant Tumors ◽  
Predictive Ability ◽  
Adverse Outcomes ◽  
Cardiac Mortality ◽  
Elective Cardiac Surgery ◽  
All Cause Mortality

Abstract Purpose ACEF (Age, Creatinine, and Ejection Fraction) andACEFMDRD (Modification of Diet in Renal Disease) score have been validated as effective predictors for prognosis in patients undergoing elective cardiac surgery or PCI. However, the predictive value for ICM (Ischemic Cardiomyopathy)was not clear. This study sought to investigate their predictive value in patients with ICM. Methods 862 ICM patients hospitalized in the Department of Cardiology were prospectively enrolled during November 2014 and December 2017.Inclusion criteria: previous definite diagnosis of myocardial infarction, previous PCI, CABG, or coronary angiographic findings of one or more vessel stenosis >70%; Simpson echocardiography showed LVEF <45%. Exclusion criteria: malignant tumors of any organ or once had a history of malignancies; and other serious diseases with estimated survival time less than one year.The ACEF score was calculated by the formula: age/ejection fraction + 1 (if creatinine >176 μmol/L). As for ACEFMDRD score, estimated glomerular filtration rate (eGFR) was calculated using the MDRD formula. Then using the formula: age/EF +1 point for every 10 mL/min reduction in eGFRMDRD below 60 ml/min per 1.73 m2 (up to a maximum of 6 points). Patients were divided into low, middle and high ACEF, ACEFMDRD tertiles. The median duration of follow-up was 13 months (IQR: 7–23 months). The clinical endpoints were all-cause mortality, cardiac mortality, major adverse cardiovascular and cerebrovascular events (MACCEs) and re-hospitalization for heart failure (HF). Results The mean original ACEF and ACEFMDRD score were 1.99±0.63 and 2.53±1.42. Patients in high ACEF and ACEFMDRD tertile were associated with significantly higher all-cause and cardiac mortality, MACCEs and re-hospitalization for HF. Compared with ACEFMDRD score, original ACEF exhibited similar discrimination and predictive ability on all-cause mortality (AUC: 0.739 vs. 0.724, P=0.567), cardiac mortality (AUC: 0.733 vs. 0.717, P=0.525), MACCEs (AUC: 0.635 vs. 0.624, P=0.587) and rehospitalizaiotn (AUC: 0.642 vs. 0.632, P=0.757). In multivariate Cox analysis, the original ACEF or ACEFMDRD score were related with increasing risks of all-cause mortality (HR: 2.00 vs. 1.32, 95% CI: 1.46–2.73 vs. 1.13–1.53, P<0.001), cardiac mortality (HR: 1.97 vs. 1.28, 95% CI: 1.43–2.70 vs. 1.10–1.50, P<0.001 vs. P=0.002), MACCEs and re-hospitalization for HF, respectively. ROC curves of cardiac mortality Conclusions In patients with ICM, the original ACEF and ACEFMDRD score are independent predictors of adverse outcomes during 13-month follow-up, respectively. Acknowledgement/Funding None

scholarly journals suPAR Cut-offs for Stratification of Low, Medium, and High-risk Acute Medical Patients in the Emergency Department

2021 ◽  
Author(s):  
Santeri Seppälä ◽  
Andreas Peter Andersen ◽  
Kristiina Nyyssönen ◽  
Jesper Eugen-Olsen ◽  
Harri Hyppölä
Keyword(s):  
High Risk ◽  
Predictive Value ◽  
Cox Regression ◽  
Medical Patients ◽  
Urokinase Plasminogen Activator Receptor ◽  
Cox Regression Analysis ◽  
Protein Levels ◽  
Reactive Protein ◽  
Roche Diagnostics

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 has been tested in this population. Methods: Prospective observational study of 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. Cox regression analysis showed that suPAR, independently of age, sex and C-reactive protein levels, predicted 30- and 90-day mortality (both p<0.001). 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 suPAR4-6 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 4-6 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 fast suPAR results that may aid in the decision of discharge or admission of acute medical patients.

scholarly journals Comparisons Between Hypothesis- and Data-Driven Approaches for Multimorbidity Frailty Index: A Machine Learning Approach (Preprint)

2019 ◽  
Author(s):  
Li-Ning Peng ◽  
Fei-Yuan Hsiao ◽  
Wei-Ju Lee ◽  
Shih-Tsung Huang ◽  
Liang-Kung Chen
Keyword(s):  
Machine Learning ◽  
Dose Response ◽  
Frailty Index ◽  
Risk Groups ◽  
Adverse Outcomes ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Machine Learning Approach ◽  
Unplanned Hospitalizations

BACKGROUND Using big data and the theory of cumulative deficits to develop the multimorbidity frailty index (mFI) has become a widely accepted approach in public health and health care services. However, constructing the mFI using the most critical determinants and stratifying different risk groups with dose-response relationships remain major challenges in clinical practice. OBJECTIVE This study aimed to develop the mFI by using machine learning methods that select variables based on the optimal fitness of the model. In addition, we aimed to further establish 4 entities of risk using a machine learning approach that would achieve the best distinction between groups and demonstrate the dose-response relationship. METHODS In this study, we used Taiwan’s National Health Insurance Research Database to develop a machine learning multimorbidity frailty index (ML-mFI) using the theory of cumulative diseases/deficits of an individual older person. Compared to the conventional mFI, in which the selection of diseases/deficits is based on expert opinion, we adopted the random forest method to select the most influential diseases/deficits that predict adverse outcomes for older people. To ensure that the survival curves showed a dose-response relationship with overlap during the follow-up, we developed the distance index and coverage index, which can be used at any time point to classify the ML-mFI of all subjects into the categories of fit, mild frailty, moderate frailty, and severe frailty. Survival analysis was conducted to evaluate the ability of the ML-mFI to predict adverse outcomes, such as unplanned hospitalizations, intensive care unit (ICU) admissions, and mortality. RESULTS The final ML-mFI model contained 38 diseases/deficits. Compared with conventional mFI, both indices had similar distribution patterns by age and sex; however, among people aged 65 to 69 years, the mean mFI and ML-mFI were 0.037 (SD 0.048) and 0.0070 (SD 0.0254), respectively. The difference may result from discrepancies in the diseases/deficits selected in the mFI and the ML-mFI. A total of 86,133 subjects aged 65 to 100 years were included in this study and were categorized into 4 groups according to the ML-mFI. Both the Kaplan-Meier survival curves and Cox models showed that the ML-mFI significantly predicted all outcomes of interest, including all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions at 1, 5, and 8 years of follow-up (<i>P</i>&lt;.01). In particular, a dose-response relationship was revealed between the 4 ML-mFI groups and adverse outcomes. CONCLUSIONS The ML-mFI consists of 38 diseases/deficits that can successfully stratify risk groups associated with all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions in older people, which indicates that precise, patient-centered medical care can be a reality in an aging society.

scholarly journals Associations of Blood Pressure and Heart Rate and Their Contribution to the Development of Cardiovascular Complications and All-Cause Mortality in the Russian Population of 25-64 Years

2020 ◽  
Vol 16 (5) ◽  
pp. 759-769
Author(s):  
S. A. Shalnova ◽  
V. A. Kutsenko ◽  
A. V. Kapustina ◽  
E. B. Yarovaya ◽  
Yu. A. Balanova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiovascular Complications ◽  
Adverse Outcomes ◽  
Average Value ◽  
Risk Of Mortality ◽  
The Right ◽  
Relationship Of ◽  
The Relationship

Aim. To study the relationship of blood pressure (BP) and heart rate (HR) in a sample of men and women 25-64 years old and their predictive value for the development of fatal and non-fatal cardiovascular diseases (CVD) and mortality from all causes.Material and methods. Prospective observation was for cohorts of the population aged 25-64 years from 11 regions of the Russian Federation. 18,251 people were included in the analysis. Each participant gave written informed consent. All surveyed persons were interviewed with a standard questionnaire. BP was measured on the right hand with an automatic tonometer. BP and HR were measured twice with an interval of 2-3 min with the calculation of the average value. The patients were divided into 4 groups: the first group with BP<140/90 ><140/90 mm Hg and HR≤80 beats/min; the second group – BP<140/><140/90 mm Hg and HR>80; the third group – BP≥140/90 mm Hg and HR≤80; the fourth group – BP≥140/90 mm Hg and HR>80 beats/min. Risk factors and cardiovascular history were analyzed as well. Deaths over 6 years of follow-up occurred in 393 people (141 – from CVD). Statistical analysis was performed using the open source R3.6.1 system.Results. A HR>80 beats/min was found in 26.3% of people with BP≥140/90 mm Hg, regardless of medication. Analysis of the associations between HR and BP showed that for every increase in HR by 10 beats/min, systolic BP increases by 3 mm Hg. (p<0.0001). The group with HR>80 beats/min and BP≥140/90 mm Hg had the shortest life expectancy (p<0.001). Adding an increased HR to BP≥140/90 mm Hg significantly><0.001). Adding an increased HR to BP≥140/90 mm Hg significantly worsened the prognosis of patients. Similar results were obtained in the analysis of cardiovascular survival. Elevated BP and elevated HR had the same effect on outcomes, except for the combined endpoint, where the contribution of elevated BP was predominant. However, their combined effect was the largest and highly significant for the development of the studied outcomes, even after adjusting for other predictors. With an increase in HR by every 10 beats/min, the risk of mortality increased statistically significantly by 22%.Conclusion. The prevalence of HR>80 beats/min in people with BP≥140 mm Hg amounted to 26.34%. Every 10 beats/min significantly increases the risk of mortality by 22%. Increased HR with elevated BP leads to increased adverse outcomes.

scholarly journals Soluble Urokinase Plasminogen Activator Receptor and Decline in Kidney Function in Autosomal Dominant Polycystic Kidney Disease

2019 ◽  
Vol 30 (7) ◽  
pp. 1305-1313 ◽  
Author(s):  
Salim S. Hayek ◽  
Douglas P. Landsittel ◽  
Changli Wei ◽  
Martin Zeier ◽  
Alan S.L. Yu ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Volume ◽  
Polycystic Kidney ◽  
Urokinase Plasminogen Activator Receptor ◽  
Total Kidney Volume ◽  
Progressive Decline ◽  
Ckd Stage ◽  
Plasminogen Activator Receptor ◽  
Autosomal Dominant Polycystic Kidney

BackgroundLevels of soluble urokinase plasminogen activator receptor (suPAR), an inflammation marker, are strongly predictive of incident kidney disease. Patients with autosomal dominant polycystic kidney disease (ADPKD) experience progressive decline in renal function, but rates of decline and outcomes vary greatly. Whether suPAR levels are predictive of declining kidney function in patients with ADPKD is unknown.MethodsWe assessed suPAR levels in 649 patients with ADPKD who underwent scheduled follow-up for at least 3 years, with repeated measurements of height-adjusted total kidney volume and creatinine-derived eGFR. We used linear mixed models for repeated measures and Cox proportional hazards to characterize associations between baseline suPAR levels and follow-up eGFR or incident ESRD.ResultsThe median suPAR level was 2.47 ng/ml and median height-adjusted total kidney volume was 778, whereas mean eGFR was 84 ml/min per 1.73 m2. suPAR levels were associated with height-adjusted total kidney volume (β=0.02; 95% confidence interval, 0.01 to 0.03), independent of age, sex, race, hypertension, and eGFR. Patients in the lowest suPAR tertile (<2.18 ng/ml) had a 6.8% decline in eGFR at 3 years and 22% developed CKD stage 3, whereas those in the highest tertile (suPAR>2.83 ng/ml) had a 19.4% decline in eGFR at 3 years and 68% developed CKD stage 3. suPAR levels >2.82 ng/ml had a 3.38-fold increase in the risk of incident ESRD.ConclusionssuPAR levels were associated with progressive decline in renal function and incident ESRD in patients with ADPKD, and may aid early identification of patients at high risk of disease progression.

Soluble urokinase plasminogen activator receptor and incidence of venous thromboembolism

2016 ◽  
Vol 115 (03) ◽  
pp. 657-662 ◽  
Author(s):  
Bengt Zöller ◽  
Peter J. Svensson ◽  
Olle Melander ◽  
Margaretha Persson ◽  
Gunnar Engström
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Plasminogen Activator ◽  
Urokinase Plasminogen Activator ◽  
Population Based ◽  
Risk Indicator ◽  
Urokinase Plasminogen Activator Receptor ◽  
Plasminogen Activator Receptor ◽  
Incident Cases

SummaryRaised plasma levels of the soluble urokinase plasminogen activator receptor (suPAR) have been associated with increased incidence of cardiovascular diseases. Whether suPAR is associated with venous thromboembolism (VTE) is largely unknown. The purpose of the present study was to investigate the relationship between suPAR and incidence of VTE in a cohort study. suPAR was measured in 5,203 subjects (aged 46–68 years, 58 % women) from the general population, who participated in the Malmö Diet and Cancer (MDC) study between 1991 and 1994. Incident cases of VTE were identified from the Swedish patient register during a mean follow-up of 15.7 years. Of 5,203 subjects with measurements of suPAR, 239 had VTE during follow-up (127 venous thrombosis, 86 lung embolism, 26 both). Incidence of VTE was significantly higher in subjects with suPAR levels in the top quartile. Adjusted for age and sex, the HR (4th vs 1st quartile) was 1.74 (95%CI: 1.2–2.6, p for trend=0.003). After adjustments for risk factors, the HR was 1.66 (95 %CI: 1.1–2.5, p for trend=0.016). High level of suPAR was a risk indicator for incidence of VTE in this population-based cohort study. The causal relationships between suPAR and VTE remain to be explored.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals Short-Term Rationing of Combination Antiretroviral Therapy: Impact on Morbidity, Mortality, and Loss to Follow-Up in a Large HIV Treatment Program in Western Kenya

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
April J. Bell ◽  
Kara Wools-Kaloustian ◽  
Sylvester Kimaiyo ◽  
Hai Liu ◽  
Adrian Katschke ◽  
...  
Keyword(s):  
Median Number ◽  
Hiv Treatment ◽  
Adverse Outcomes ◽  
Short Term ◽  
Cox Models ◽  
Western Kenya ◽  
Loss To Follow Up ◽  
Risk Of Mortality ◽  
Short Period

Background. There was a 6-month shortage of antiretrovirals (cART) in Kenya.Methods. We assessed morbidity, mortality, and loss to follow-up (LTFU) in this retrospective analysis of adults who were enrolled during the six-month period with restricted cART (cap) or the six months prior (pre-cap) and eligible for cART at enrollment by the pre-cap standard. Cox models were used to adjust for potential confounders.Results. 9009 adults were eligible for analysis: 4,714 pre-cap and 4,295 during the cap. Median number of days from enrollment to cART initiation was 42 pre-cap and 56 for the cap (P<0.001). After adjustment, individuals in the cap were at higher risk of mortality (HR=1.21; 95% CI : 1.06–1.39) and LTFU (HR=1.12; 95% CI : 1.04–1.22). There was no difference between the groups in their risk of developing a new AIDS-defining illness (HR=0.9295% CI 0.82–1.03).Conclusions. Rationing of cART, even for a relatively short period of six months, led to clinically adverse outcomes.

Sign in / Sign up

Export Citation Format

Share Document