suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department

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 have been tested in this population. Methods Prospective observational study...

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Autores principales:	Seppälä Santeri, Andersen Andreas Peter, Nyyssönen Kristiina, Eugen-Olsen Jesper, Hyppölä Harri
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	suPAR Laboratory marker Emergency department Mortality Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/08dd577ae27b451d8982d16e8af4d0f9
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spelling	oai:doaj.org-article:08dd577ae27b451d8982d16e8af4d0f92021-12-05T12:10:33ZsuPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department10.1186/s12873-021-00544-x1471-227Xhttps://doaj.org/article/08dd577ae27b451d8982d16e8af4d0f92021-11-01T00:00:00Zhttps://doi.org/10.1186/s12873-021-00544-xhttps://doaj.org/toc/1471-227XAbstract 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 have been tested in this population. Methods Prospective 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. 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. 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%. Conclusions suPAR 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.Seppälä SanteriAndersen Andreas PeterNyyssönen KristiinaEugen-Olsen JesperHyppölä HarriBMCarticlesuPARLaboratory markerEmergency departmentMortalitySpecial situations and conditionsRC952-1245Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENBMC Emergency Medicine, Vol 21, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	suPAR Laboratory marker Emergency department Mortality Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	suPAR Laboratory marker Emergency department Mortality Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Seppälä Santeri Andersen Andreas Peter Nyyssönen Kristiina Eugen-Olsen Jesper Hyppölä Harri suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department
description	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 have been tested in this population. Methods Prospective 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. 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. 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%. Conclusions suPAR 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.
format	article
author	Seppälä Santeri Andersen Andreas Peter Nyyssönen Kristiina Eugen-Olsen Jesper Hyppölä Harri
author_facet	Seppälä Santeri Andersen Andreas Peter Nyyssönen Kristiina Eugen-Olsen Jesper Hyppölä Harri
author_sort	Seppälä Santeri
title	suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department
title_short	suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department
title_full	suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department
title_fullStr	suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department
title_full_unstemmed	suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department
title_sort	supar cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department
publisher	BMC
publishDate	2021
url	https://doaj.org/article/08dd577ae27b451d8982d16e8af4d0f9
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suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department

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