Department of Infectious Diseases, Satakunta Central Hospital, Pori, Finland.
J Intern Med. 2012 Sep;272(3):247-56. doi: 10.1111/j.1365-2796.2012.02569.x. Epub 2012 Jul 29.
The soluble form of urokinase-type plasminogen activator (suPAR) was evaluated as an early prognostic marker of sepsis in patients with suspected infection.
A single-centre prospective cohort study.
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.
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 (AUC(ROC) ) 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.
A high suPAR level predicts case fatality and severe sepsis in patients with suspected infection.
评估尿激酶型纤溶酶原激活物的可溶性形式（suPAR）作为疑似感染患者脓毒症的早期预后标志物。
单中心前瞻性队列研究。
该队列包括急诊科 539 名疑似感染患者：59 名无全身炎症反应综合征（SIRS）且无细菌感染（组 1），68 名有细菌感染但无 SIRS（组 2），54 名有 SIRS 但无细菌感染（组 3），309 名有脓毒症（SIRS 和细菌感染）但无器官功能衰竭（组 4）和 49 名严重脓毒症（SIRS、细菌感染和器官功能衰竭）（组 5）。使用商业固相酶联免疫吸附试验在入院时测量可溶性受体（suPAR）浓度。
组 1-5 的可溶性受体（suPAR）浓度中位数分别为 4.7、5.0、4.4、4.8 和 7.9ng/mL（P<0.001）。与幸存者相比，非幸存者的水平显著升高（8.3 与 4.9ng/mL，P<0.001），与其他组相比，严重脓毒症患者（组 5）的水平也显著升高（7.9 与 4.8ng/mL，P<0.001）。预测病死率的受试者工作特征曲线下面积（AUC（ROC））为 0.79（95%置信区间[CI]：0.72-0.86，P<0.0001），严重脓毒症为 0.75（95%CI：0.68-0.81，P<0.0001）。suPAR 截断值为 6.4ng/mL 时，对致命疾病的敏感性为 76%，特异性为 69%；截断值为 6.6ng/mL 时，严重脓毒症的敏感性和特异性分别为 67%和 72%。在多变量模型中，在调整潜在混杂因素后，高 suPAR 仍然是病死率和严重脓毒症的独立预测因素。
高 suPAR 水平可预测疑似感染患者的病死率和严重脓毒症。
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