Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, PO Box 348, 00029 HUS, Helsinki, Finland.
Eur J Clin Microbiol Infect Dis. 2011 Nov;30(11):1417-24. doi: 10.1007/s10096-011-1236-8. Epub 2011 Apr 12.
The soluble form of urokinase-type plasminogen activator receptor (suPAR) is a new inflammatory marker. High suPAR levels have been shown to associate with mortality in cancer and in chronic infections like HIV and tuberculosis, but reports on the role of suPAR in acute bacteremic infections are scarce. To elucidate the role of suPAR in a common bacteremic infection, the serum suPAR levels in 59 patients with Staphylococcus aureus bacteremia (SAB) were measured using the suPARnostic ELISA assay and associations to 1-month mortality and with deep infection focus were analyzed. On day three, after the first positive blood culture for S. aureus, suPAR levels were higher in 19 fatalities (median 12.3; range 5.7-64.6 ng/mL) than in 40 survivors (median 8.4; range 3.7-17.6 ng/mL, p = 0.002). This difference persisted for 10 days. The presence of deep infection focus was not associated with elevated suPAR levels as compared to patients with no deep infection focus. suPAR was found to be prognostic for mortality in receiver operator characteristic (ROC) curve analysis, which was not observed for serum C-reactive protein (CRP); the area under the curve (AUC) for suPAR was 0.754 (95% confidence interval [CI], 0.615-0.894, p = 0.003) and for CRP, it was 0.596 (95% CI, 0.442-0.750, p = 0.253). The optimal suPAR cut-off value in predicting 1-month mortality was 9.25 ng/mL. In conclusion, our study demonstrates that the new promising biomarker, serum suPAR concentration, was able to predict mortality in SAB.
尿激酶型纤溶酶原激活物受体的可溶性形式（suPAR）是一种新的炎症标志物。高 suPAR 水平已被证明与癌症和 HIV 及结核病等慢性感染的死亡率相关，但关于 suPAR 在急性菌血症感染中的作用的报告很少。为了阐明 suPAR 在常见菌血症感染中的作用，使用 suPARnostic ELISA 测定法测量了 59 例金黄色葡萄球菌菌血症（SAB）患者的血清 suPAR 水平，并分析了与 1 个月死亡率和深部感染病灶的关联。在第 3 天，在第一次金黄色葡萄球菌阳性血培养后，19 例死亡患者（中位数 12.3；范围 5.7-64.6 ng/mL）的 suPAR 水平高于 40 例存活患者（中位数 8.4；范围 3.7-17.6 ng/mL，p = 0.002）。这种差异持续了 10 天。与没有深部感染病灶的患者相比，深部感染病灶的存在与升高的 suPAR 水平无关。在受试者工作特征（ROC）曲线分析中发现 suPAR 对死亡率具有预后价值，而血清 C 反应蛋白（CRP）则没有；suPAR 的曲线下面积（AUC）为 0.754（95%置信区间 [CI]，0.615-0.894，p = 0.003），CRP 的 AUC 为 0.596（95% CI，0.442-0.750，p = 0.253）。预测 1 个月死亡率的最佳 suPAR 截断值为 9.25 ng/mL。总之，我们的研究表明，新型有前途的生物标志物血清 suPAR 浓度能够预测 SAB 的死亡率。
