Soluble urokinase plasminogen activator receptor predicts mortality in patients with systemic inflammatory response syndrome

Authors

  • R. B. Raggam,

    1. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
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  • J. Wagner,

    1. Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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  • F. Prüller,

    1. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
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  • A. Grisold,

    1. Institute of Hygiene, Microbiology and Environmental Health, Medical University of Graz, Graz, Austria
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  • E. Leitner,

    1. Institute of Hygiene, Microbiology and Environmental Health, Medical University of Graz, Graz, Austria
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  • I. Zollner-Schwetz,

    1. Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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  • T. Valentin,

    1. Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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  • R. Krause,

    Corresponding author
    1. Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
    • Correspondence: Martin Hoenigl, MD, and Robert Krause, MD, Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.

      (fax: +4331638514622; e-mail: martin.hoenigl@medunigraz.at and robert.krause@medunigraz.at).

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  • M. Hoenigl

    Corresponding author
    1. Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
    2. Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
    • Correspondence: Martin Hoenigl, MD, and Robert Krause, MD, Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.

      (fax: +4331638514622; e-mail: martin.hoenigl@medunigraz.at and robert.krause@medunigraz.at).

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Abstract

Objective

The soluble urokinase plasminogen activator receptor (suPAR) reflects inflammation. However, the prognostic value of suPAR measurements, particularly at the very early onset of systemic inflammatory response syndrome (SIRS), is less well defined.

Methods

The prognostic potential of suPAR levels in patients with SIRS was evaluated. From November 2010 until April 2013, 902 adult patients presenting with SIRS were investigated. Blood samples for laboratory testing of inflammation markers were collected simultaneously with initial blood cultures. suPAR testing was performed using suPARnostic© assay.

Results

Analyses of receiver operating characteristics curves revealed areas under the curve (AUCs) of 0.818 for predicting overall mortality within 48 h (36/902 patients died), 0.739 for 30-day mortality (117/902 died) and 0.706 for predicting 90-day mortality (151/902 died). AUCs for procalcitonin (0.777, 0.671 and 0.638), interleukin-6 (0.709, 0.593 and 0.569) and C-reactive protein (0.66, 0.594 and 0.586) as well as renal function and age were markedly lower. Using multivariable regression analyses, suPAR levels (P < 0.001) remained significant predictors of 48-h mortality, whereas suPAR levels (P < 0.001) and bacteraemia (P = 0.002 and P = 0.001, respectively) remained significant predictors of 30- and 90-day mortality. Using Kaplan–Meier survival plots, patients with suPAR <9.15 ng mL−1 at SIRS onset had a clear benefit.

Conclusion

suPAR plasma level determined at early SIRS is predictive for mortality.

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