Reinhard B. Raggam and Jasmin Wagner contributed equally to the work.
Soluble urokinase plasminogen activator receptor predicts mortality in patients with systemic inflammatory response syndrome
Article first published online: 8 APR 2014
© 2014 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 276, Issue 6, pages 651–658, December 2014
How to Cite
Soluble urokinase plasminogen activator receptor predicts mortality in patients with systemic inflammatory response syndrome. J Intern Med 2014; 276: 651–658., , , , , , , , (Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz; Medical University of Graz, Graz; Institute of Hygiene, Microbiology and Environmental Health, Division of Pulmonology, Medical University of Graz, Graz, Austria).
Parts of the study were presented at the 23rd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Berlin, Germany (oral presentation #420).
- Issue published online: 24 NOV 2014
- Article first published online: 8 APR 2014
- Accepted manuscript online: 19 MAR 2014 09:50AM EST
- laboratory biomarker;
- mortality, prediction;
- soluble urokinase plasminogen activator receptor;
- systemic inflammatory response syndrome
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.
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.
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.
suPAR plasma level determined at early SIRS is predictive for mortality.