scholarly journals Prognostic power of soluble urokinase plasminogen activator receptor (suPAR) for short-term mortality in patients seen in Emergency Departments due to infections

2021 ◽  
Author(s):  
Rafael Rubio Díaz ◽  
Elena de Rafael González ◽  
Esther Martín Torres ◽  
Elena Valera Núñez ◽  
Aurora María López Martos ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Analytical Study ◽  
Mixed Model ◽  
Area Under The Curve ◽  
Urokinase Plasminogen Activator Receptor ◽  
Reactive Protein ◽  
Failure Assessment ◽  
Short Term Mortality ◽  
Plasminogen Activator Receptor ◽  
Prognostic Power

Objectives. To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate and suPAR) in patients seen in emergency departments (ED) due to infections. Secondly, if these could improve the accuracy of systemic inflammatory response syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA). Methods. A prospective, observational and analytical study was carried out on patients who were treated in an ED of one of the eight participating hospitals. An assessment was made of 32 independent variables that could influence mortality at 30 days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Results. The study included 347 consecutive patients, 54 (15.6%) of whom died within 30 days of visiting the ED. SUPAR has got the best biomarker area under the curve (AUC)-ROC to predict mortality at 30 days of 0.836 (95% CI: 0.765-0.907; P <.001) with a cut-off > 10 ng/mL who had a sensitivity of 70% and a specificity of 86%. The score qSOFA ≥ 2 had AUC-ROC of 0.707 (95% CI: 0.621-0.793; P < .001) with sensitivity of 53% and a specificity of 89%. The mixed model (suPAR > 10 ng/mL plus qSOFA ≥ 2) has improved the AUC-ROC to 0.853 [95% CI: 0.790-0.916; P < .001] with the best prognostic performance: sensitivity of 39% and a specificity of 97% with a negative predictive value of 90%. Conclusions. suPAR showed better performance for 30-day mortality prognostic power from several biomarkers in the patients seen in ED due to infections. Score qSOFA has better performance that SRIS and the mixed model (qSOFA ≥ 2 plus suPAR > 10 ng/mL) increased the ability of qSOFA.

Diagnostic Accuracy of Procalcitonin and C-reactive Protein Is Insufficient to Predict Proven Infection: A Retrospective Cohort Study in Critically Ill Patients Fulfilling the Sepsis-3 Criteria

2019 ◽  
Vol 5 (1) ◽  
pp. 62-72
Author(s):  
Jos A H van Oers ◽  
Evelien de Jong ◽  
Hans Kemperman ◽  
Armand R J Girbes ◽  
Dylan W de Lange
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Recognition ◽  
Area Under The Curve ◽  
Index Test ◽  
C Reactive Protein ◽  
Suspected Infection ◽  
Reactive Protein ◽  
Failure Assessment

Abstract Background New Sepsis-3 definitions facilitate early recognition of patients with sepsis. In this study we investigated whether a single initial determination of procalcitonin (PCT) or C-reactive protein (CRP) in plasma can predict proven sepsis in Sepsis-3 criteria-positive critically ill patients. We also investigated whether a decline in serial PCT or CRP can predict outcome in 28-day mortality. Methods Patients, ≥18 years of age, at the intensive care unit with a suspected infection, a Sequential Organ Failure Assessment (SOFA) score of ≥2 points, and an index test PCT and CRP at admission were selected from a prospectively collected cohort. PCT and CRP were studied retrospectively with the Mann–Whitney U-test and ROC analysis. Results In total, 157 patients were selected; 63 of the 157 had proven sepsis, and sepsis could not be detected in 94 of the 157. Neither a single PCT nor CRP at admission was able to discriminate proven sepsis from nonproven sepsis (PCT, 1.8 μg/L and 1.5 μg/L, respectively, P = 0.25; CRP, 198 mg/L and 186 mg/L, respectively, P = 0.53). Area under the curve for both PCT and CRP for detecting proven sepsis was low (0.55 and 0.53). Furthermore, neither a decline from baseline to day 5 PCT nor CRP could predict 28-day mortality (PCT, 50% vs 46%, P = 0.83; CRP, 30% vs 40%, P = 0.51). Conclusion PCT and CRP at admission were not able to discern patients with proven sepsis in Sepsis-3 criteria-positive critically ill patients. A decline of PCT and CRP in 5 days was not able to predict 28-day mortality.

scholarly journals Soluble urokinase plasminogen activator receptor for the prediction of ventilator-associated pneumonia

2019 ◽  
Vol 5 (1) ◽  
pp. 00212-2018 ◽  
Author(s):  
Pouline M. van Oort ◽  
Lieuwe D. Bos ◽  
Pedro Póvoa ◽  
Paula Ramirez ◽  
Antoni Torres ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Critically Ill ◽  
Pulmonary Infection ◽  
Urokinase Plasminogen Activator ◽  
Clinical Pulmonary Infection Score ◽  
Ventilator Associated Pneumonia ◽  
C Reactive Protein ◽  
Urokinase Plasminogen Activator Receptor ◽  
Reactive Protein ◽  
Plasminogen Activator Receptor

IntroductionDiagnosing ventilator-associated pneumonia (VAP) remains challenging. Soluble urokinase plasminogen activator receptor (suPAR) has prognostic value in critically ill patients with systemic infection. We hypothesised that plasma suPAR levels accurately predict development of VAP.MethodsThis observational, multicentre, prospective cohort study compared patients at risk for VAP with a control group. Plasma and tracheal aspirate samples were collected. Plasma suPAR levels were measured on the day of diagnosis and 3 days before diagnosis.ResultsThe study included 24 VAP patients and 19 control patients. The suPAR concentration measured 3 days before diagnosis was significantly increased in VAP patients versus matched samples of control patients (area under the receiver operating characteristic curve (AUC) 0.68, 95% CI 0.52–1.00; p=0.04). Similar results were found on the day of diagnosis (AUC 0.77, 95% CI 0.6–0.93; p=0.01). Plasma suPAR was significantly higher in deceased patients (AUC 0.79, 95% CI 0.57–1.00; p<0.001). Combining suPAR with the Clinical Pulmonary Infection Score, C-reactive protein and/or procalcitonin led to a significantly increased discriminative accuracy for predicting VAP and an increased specificity.ConclusionssuPAR can be used to diagnose VAP with a fair diagnostic accuracy and has a moderate prognostic accuracy to be used in critically ill intensive care unit patients. Its performance improves when added to other clinically available biomarkers (C-reactive protein and procalcitonin) or scoring systems (Clinical Pulmonary Infection Score and Sepsis-related Organ Failure Assessment).

Sign in / Sign up

Export Citation Format

Share Document