Soluble urokinase-type plasminogen activator receptor in patients with suspected infection in the emergency room: a prospective cohort study
Objectives The soluble form of urokinase‐type plasminogen activator (suPAR) was evaluated as an early prognostic marker of sepsis in patients with suspected infection. Design A single‐centre prospective cohort study. Methods The cohort comprised 539 patients in the emergency department with suspecte...
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| Veröffentlicht in: | Journal of internal medicine 2012-09, Vol.272 (3), p.247-256 |
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| creator | Uusitalo-Seppälä, R. Huttunen, R. Tarkka, M. Aittoniemi, J. Koskinen, P. Leino, A. Vahlberg, T. Rintala, E. M. |
| description | Objectives
The soluble form of urokinase‐type plasminogen activator (suPAR) was evaluated as an early prognostic marker of sepsis in patients with suspected infection.
Design
A single‐centre prospective cohort study.
Methods
The cohort comprised 539 patients in the emergency department with suspected infection: 59 without systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 68 with bacterial infection and without SIRS (group 2), 54 with SIRS and without bacterial infection (group 3), 309 with sepsis (SIRS and bacterial infection) and without organ failure (group 4) and 49 with severe sepsis (SIRS, bacterial infection and organ failure) (group 5). suPAR was measured on admission using a commercial solid‐phase enzyme‐linked immunosorbent assay.
Results
The median soluble form of the receptor (suPAR) concentrations in groups 1–5 were 4.7, 5.0, 4.4, 4.8 and 7.9 ng mL−1, respectively (P |
| doi_str_mv | 10.1111/j.1365-2796.2012.02569.x |
| format | Article |
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The soluble form of urokinase‐type plasminogen activator (suPAR) was evaluated as an early prognostic marker of sepsis in patients with suspected infection.
Design
A single‐centre prospective cohort study.
Methods
The cohort comprised 539 patients in the emergency department with suspected infection: 59 without systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 68 with bacterial infection and without SIRS (group 2), 54 with SIRS and without bacterial infection (group 3), 309 with sepsis (SIRS and bacterial infection) and without organ failure (group 4) and 49 with severe sepsis (SIRS, bacterial infection and organ failure) (group 5). suPAR was measured on admission using a commercial solid‐phase enzyme‐linked immunosorbent assay.
Results
The median soluble form of the receptor (suPAR) concentrations in groups 1–5 were 4.7, 5.0, 4.4, 4.8 and 7.9 ng mL−1, respectively (P < 0.001). The levels were significantly higher in nonsurvivors compared with survivors (8.3 vs. 4.9 ng mL−1, P < 0.001) and in patients with severe sepsis (group 5) compared with those in the other groups (7.9 vs. 4.8 ng mL−1, P < 0.001). Area under the receiver operating characteristics curve (AUCROC
) for the prediction of case fatality was 0.79 (95% confidence interval [CI]: 0.72–0.86, P < 0.0001) and 0.75 for severe sepsis (95% CI: 0.68–0.81, P < 0.0001). At a cut‐off level of 6.4 ng mL−1, suPAR had 76% sensitivity and 69% specificity for fatal disease; at a cut‐off level of 6.6 ng mL−1, the sensitivity and specificity for severe sepsis were 67% and 72%, respectively. In multivariate models, high suPAR remained an independent predictor of case fatality and severe sepsis after adjusting for potential confounders.
Conclusions
A high suPAR level predicts case fatality and severe sepsis in patients with suspected infection.</description><identifier>ISSN: 0954-6820</identifier><identifier>EISSN: 1365-2796</identifier><identifier>DOI: 10.1111/j.1365-2796.2012.02569.x</identifier><identifier>PMID: 22755554</identifier><language>eng</language><publisher>Oxford: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacterial diseases ; Bacterial Infections - blood ; Bacterial Infections - diagnosis ; Bacterial Infections - mortality ; Bacterial sepsis ; Biological and medical sciences ; biomarker ; Biomarkers - blood ; Calcitonin - blood ; case fatality ; emergency room ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Female ; General aspects ; Human bacterial diseases ; Humans ; infection ; Infectious diseases ; Interleukin-6 - blood ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Multivariate Analysis ; Prognosis ; Prospective Studies ; Protein Precursors - blood ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; ROC Curve ; Sensitivity and Specificity ; Sepsis - blood ; Sepsis - diagnosis ; Sepsis - mortality ; severe sepsis ; Severity of Illness Index ; suPAR ; Systemic Inflammatory Response Syndrome - blood ; Systemic Inflammatory Response Syndrome - diagnosis ; Systemic Inflammatory Response Syndrome - mortality ; Urokinase-Type Plasminogen Activator - blood ; Young Adult</subject><ispartof>Journal of internal medicine, 2012-09, Vol.272 (3), p.247-256</ispartof><rights>2012 The Association for the Publication of the Journal of Internal Medicine</rights><rights>2015 INIST-CNRS</rights><rights>2012 The Association for the Publication of the Journal of Internal Medicine.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4889-4c5b04ab31a4d5ff9a797f8ce294860cf28b8482295f4be4cbf04a3c561f48f73</citedby><cites>FETCH-LOGICAL-c4889-4c5b04ab31a4d5ff9a797f8ce294860cf28b8482295f4be4cbf04a3c561f48f73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1365-2796.2012.02569.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1365-2796.2012.02569.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26332768$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22755554$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Uusitalo-Seppälä, R.</creatorcontrib><creatorcontrib>Huttunen, R.</creatorcontrib><creatorcontrib>Tarkka, M.</creatorcontrib><creatorcontrib>Aittoniemi, J.</creatorcontrib><creatorcontrib>Koskinen, P.</creatorcontrib><creatorcontrib>Leino, A.</creatorcontrib><creatorcontrib>Vahlberg, T.</creatorcontrib><creatorcontrib>Rintala, E. M.</creatorcontrib><title>Soluble urokinase-type plasminogen activator receptor in patients with suspected infection in the emergency room: a prospective cohort study</title><title>Journal of internal medicine</title><addtitle>J Intern Med</addtitle><description>Objectives
The soluble form of urokinase‐type plasminogen activator (suPAR) was evaluated as an early prognostic marker of sepsis in patients with suspected infection.
Design
A single‐centre prospective cohort study.
Methods
The cohort comprised 539 patients in the emergency department with suspected infection: 59 without systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 68 with bacterial infection and without SIRS (group 2), 54 with SIRS and without bacterial infection (group 3), 309 with sepsis (SIRS and bacterial infection) and without organ failure (group 4) and 49 with severe sepsis (SIRS, bacterial infection and organ failure) (group 5). suPAR was measured on admission using a commercial solid‐phase enzyme‐linked immunosorbent assay.
Results
The median soluble form of the receptor (suPAR) concentrations in groups 1–5 were 4.7, 5.0, 4.4, 4.8 and 7.9 ng mL−1, respectively (P < 0.001). The levels were significantly higher in nonsurvivors compared with survivors (8.3 vs. 4.9 ng mL−1, P < 0.001) and in patients with severe sepsis (group 5) compared with those in the other groups (7.9 vs. 4.8 ng mL−1, P < 0.001). Area under the receiver operating characteristics curve (AUCROC
) for the prediction of case fatality was 0.79 (95% confidence interval [CI]: 0.72–0.86, P < 0.0001) and 0.75 for severe sepsis (95% CI: 0.68–0.81, P < 0.0001). At a cut‐off level of 6.4 ng mL−1, suPAR had 76% sensitivity and 69% specificity for fatal disease; at a cut‐off level of 6.6 ng mL−1, the sensitivity and specificity for severe sepsis were 67% and 72%, respectively. In multivariate models, high suPAR remained an independent predictor of case fatality and severe sepsis after adjusting for potential confounders.
Conclusions
A high suPAR level predicts case fatality and severe sepsis in patients with suspected infection.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bacterial diseases</subject><subject>Bacterial Infections - blood</subject><subject>Bacterial Infections - diagnosis</subject><subject>Bacterial Infections - mortality</subject><subject>Bacterial sepsis</subject><subject>Biological and medical sciences</subject><subject>biomarker</subject><subject>Biomarkers - blood</subject><subject>Calcitonin - blood</subject><subject>case fatality</subject><subject>emergency room</subject><subject>Emergency Service, Hospital</subject><subject>Enzyme-Linked Immunosorbent Assay</subject><subject>Female</subject><subject>General aspects</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>infection</subject><subject>Infectious diseases</subject><subject>Interleukin-6 - blood</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Multivariate Analysis</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Protein Precursors - blood</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Sepsis - blood</subject><subject>Sepsis - diagnosis</subject><subject>Sepsis - mortality</subject><subject>severe sepsis</subject><subject>Severity of Illness Index</subject><subject>suPAR</subject><subject>Systemic Inflammatory Response Syndrome - blood</subject><subject>Systemic Inflammatory Response Syndrome - diagnosis</subject><subject>Systemic Inflammatory Response Syndrome - mortality</subject><subject>Urokinase-Type Plasminogen Activator - blood</subject><subject>Young Adult</subject><issn>0954-6820</issn><issn>1365-2796</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkcGO0zAQhi0EYsvCKyBfkLikOI7jOByQYAVlV4UVAsTRctwxdTeJg-3sNu_AQ-NsS7kyF4803_z-9Q9COCfLPNWr3TIveJnRquZLSnK6JLTk9XL_AC1Og4doQeqSZVxQcoaehLAjJC8IJ4_RGaVVmYot0O-vrh2bFvDo3Y3tVYAsTgPgoVWhs737CT1WOtpbFZ3HHjQMc2N7PKhooY8B39m4xWEMA-gImzQyqbGun6G4BQwd-CSjJ-yd615jhQfv7ml7C1i7rfMRhzhupqfokVFtgGfH9xx9__D-28XHbH29urx4u840E6LOmC4bwlRT5IptSmNqVdWVERpozQQn2lDRCCYorUvDGmC6MQkvdMlzw4SpinP08qCbjPwaIUTZ2aChbVUPbgwyJwUXVZULkVBxQHXyHDwYOXjbKT8lSM63kDs5Ry7nyOV8C3l_C7lPq8-Pv4xNB5vT4t_wE_DiCKigVWu86rUN_zheFLTis4c3B-7OtjD9twF5dX35aW6TQHYQsCHC_iSg_I3kVVGV8sfnlVyxdSnekS_yqvgDk124Bw</recordid><startdate>201209</startdate><enddate>201209</enddate><creator>Uusitalo-Seppälä, R.</creator><creator>Huttunen, R.</creator><creator>Tarkka, M.</creator><creator>Aittoniemi, J.</creator><creator>Koskinen, P.</creator><creator>Leino, A.</creator><creator>Vahlberg, T.</creator><creator>Rintala, E. M.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201209</creationdate><title>Soluble urokinase-type plasminogen activator receptor in patients with suspected infection in the emergency room: a prospective cohort study</title><author>Uusitalo-Seppälä, R. ; Huttunen, R. ; Tarkka, M. ; Aittoniemi, J. ; Koskinen, P. ; Leino, A. ; Vahlberg, T. ; Rintala, E. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4889-4c5b04ab31a4d5ff9a797f8ce294860cf28b8482295f4be4cbf04a3c561f48f73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bacterial diseases</topic><topic>Bacterial Infections - blood</topic><topic>Bacterial Infections - diagnosis</topic><topic>Bacterial Infections - mortality</topic><topic>Bacterial sepsis</topic><topic>Biological and medical sciences</topic><topic>biomarker</topic><topic>Biomarkers - blood</topic><topic>Calcitonin - blood</topic><topic>case fatality</topic><topic>emergency room</topic><topic>Emergency Service, Hospital</topic><topic>Enzyme-Linked Immunosorbent Assay</topic><topic>Female</topic><topic>General aspects</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>infection</topic><topic>Infectious diseases</topic><topic>Interleukin-6 - blood</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Multivariate Analysis</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Protein Precursors - blood</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Sepsis - blood</topic><topic>Sepsis - diagnosis</topic><topic>Sepsis - mortality</topic><topic>severe sepsis</topic><topic>Severity of Illness Index</topic><topic>suPAR</topic><topic>Systemic Inflammatory Response Syndrome - blood</topic><topic>Systemic Inflammatory Response Syndrome - diagnosis</topic><topic>Systemic Inflammatory Response Syndrome - mortality</topic><topic>Urokinase-Type Plasminogen Activator - blood</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Uusitalo-Seppälä, R.</creatorcontrib><creatorcontrib>Huttunen, R.</creatorcontrib><creatorcontrib>Tarkka, M.</creatorcontrib><creatorcontrib>Aittoniemi, J.</creatorcontrib><creatorcontrib>Koskinen, P.</creatorcontrib><creatorcontrib>Leino, A.</creatorcontrib><creatorcontrib>Vahlberg, T.</creatorcontrib><creatorcontrib>Rintala, E. M.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Uusitalo-Seppälä, R.</au><au>Huttunen, R.</au><au>Tarkka, M.</au><au>Aittoniemi, J.</au><au>Koskinen, P.</au><au>Leino, A.</au><au>Vahlberg, T.</au><au>Rintala, E. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Soluble urokinase-type plasminogen activator receptor in patients with suspected infection in the emergency room: a prospective cohort study</atitle><jtitle>Journal of internal medicine</jtitle><addtitle>J Intern Med</addtitle><date>2012-09</date><risdate>2012</risdate><volume>272</volume><issue>3</issue><spage>247</spage><epage>256</epage><pages>247-256</pages><issn>0954-6820</issn><eissn>1365-2796</eissn><abstract>Objectives
The soluble form of urokinase‐type plasminogen activator (suPAR) was evaluated as an early prognostic marker of sepsis in patients with suspected infection.
Design
A single‐centre prospective cohort study.
Methods
The cohort comprised 539 patients in the emergency department with suspected infection: 59 without systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 68 with bacterial infection and without SIRS (group 2), 54 with SIRS and without bacterial infection (group 3), 309 with sepsis (SIRS and bacterial infection) and without organ failure (group 4) and 49 with severe sepsis (SIRS, bacterial infection and organ failure) (group 5). suPAR was measured on admission using a commercial solid‐phase enzyme‐linked immunosorbent assay.
Results
The median soluble form of the receptor (suPAR) concentrations in groups 1–5 were 4.7, 5.0, 4.4, 4.8 and 7.9 ng mL−1, respectively (P < 0.001). The levels were significantly higher in nonsurvivors compared with survivors (8.3 vs. 4.9 ng mL−1, P < 0.001) and in patients with severe sepsis (group 5) compared with those in the other groups (7.9 vs. 4.8 ng mL−1, P < 0.001). Area under the receiver operating characteristics curve (AUCROC
) for the prediction of case fatality was 0.79 (95% confidence interval [CI]: 0.72–0.86, P < 0.0001) and 0.75 for severe sepsis (95% CI: 0.68–0.81, P < 0.0001). At a cut‐off level of 6.4 ng mL−1, suPAR had 76% sensitivity and 69% specificity for fatal disease; at a cut‐off level of 6.6 ng mL−1, the sensitivity and specificity for severe sepsis were 67% and 72%, respectively. In multivariate models, high suPAR remained an independent predictor of case fatality and severe sepsis after adjusting for potential confounders.
Conclusions
A high suPAR level predicts case fatality and severe sepsis in patients with suspected infection.</abstract><cop>Oxford</cop><pub>Blackwell Publishing Ltd</pub><pmid>22755554</pmid><doi>10.1111/j.1365-2796.2012.02569.x</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0954-6820 |
| ispartof | Journal of internal medicine, 2012-09, Vol.272 (3), p.247-256 |
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| source | MEDLINE; IngentaConnect Free/Open Access Journals; Wiley Online Library Journals Frontfile Complete; Wiley Online Library Free Content; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adolescent Adult Aged Aged, 80 and over Bacterial diseases Bacterial Infections - blood Bacterial Infections - diagnosis Bacterial Infections - mortality Bacterial sepsis Biological and medical sciences biomarker Biomarkers - blood Calcitonin - blood case fatality emergency room Emergency Service, Hospital Enzyme-Linked Immunosorbent Assay Female General aspects Human bacterial diseases Humans infection Infectious diseases Interleukin-6 - blood Male Medical sciences Middle Aged Miscellaneous Multivariate Analysis Prognosis Prospective Studies Protein Precursors - blood Public health. Hygiene Public health. Hygiene-occupational medicine ROC Curve Sensitivity and Specificity Sepsis - blood Sepsis - diagnosis Sepsis - mortality severe sepsis Severity of Illness Index suPAR Systemic Inflammatory Response Syndrome - blood Systemic Inflammatory Response Syndrome - diagnosis Systemic Inflammatory Response Syndrome - mortality Urokinase-Type Plasminogen Activator - blood Young Adult |
| title | Soluble urokinase-type plasminogen activator receptor in patients with suspected infection in the emergency room: a prospective cohort study |
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