Critical Care Medicine Research Group, Department of Intensive Care Medicine, Tampere University Hospital, PO BOX 2000, 33521 Tampere, Finland.
Intensive Care Med. 2013 Mar;39(3):489-96. doi: 10.1007/s00134-012-2730-x. Epub 2012 Oct 26.
SuPAR (soluble urokinase plasminogen activator receptor) and PAI-1 (plasminogen activator inhibitor 1) are active in the coagulation-fibrinolysis pathway. Both have been suggested as biomarkers for disease severity. We evaluated them in prediction of mortality, acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), sepsis and renal replacement therapy (RRT) in operative and non-operative ventilated patients.
We conducted a prospective, multicenter, observational study. Blood samples and data of intensive care were collected. Mechanically ventilated patients with baseline suPAR and PAI-1 measurements were included in the analysis, and healthy volunteers were analysed for comparison. Receiver operating characteristics (ROC), logistic regression, likelihood ratios and Kaplan-Meier analysis were performed.
Baseline suPAR was 11.6 ng/ml (quartiles Q1-Q3, 9.6-14.0), compared to healthy volunteers with suPAR of 0.6 ng/ml (0.5-11.0). PAI-1 concentrations were 2.67 ng/ml (1.53-4.69) and 0.3 ng/ml (0.3-0.4), respectively. ROC analysis for suPAR 90-day mortality areas under receiver operating characteristic curves (AUC) 0.61 (95 % confidence interval (CI): 0.55-0.67), sepsis 0.68 (0.61-0.76), ALI/ARDS 0.64 (0.56-0.73) and RRT 0.65 (0.56-0.73). Patients with the highest quartile of suPAR concentrations had an odds ratio of 2.52 (1.37-4.64, p = 0.003) for 90-day mortality and 3.16 (1.19-8.41, p = 0.02) for ALI/ARDS. In non-operative patients, the AUC's for suPAR were 90-day mortality 0.61 (0.54-0.68), RRT 0.73 (0.64-0.83), sepsis 0.70 (0.60-0.80), ALI/ARDS 0.61 (0.51-0.71). Predictive value of PAI-1 was negligible.
In non-operative patients, low concentrations of suPAR were predictive for survival and high concentrations for RRT and mortality. SuPAR may be used for screening for patients with potentially good survival. The association with RRT may supply an early warning sign for acute renal failure.
suPAR（可溶性尿激酶型纤溶酶原激活物受体）和 PAI-1（纤溶酶原激活物抑制剂 1）在凝血-纤溶途径中活跃。两者均被认为是疾病严重程度的生物标志物。我们评估了它们在手术和非手术通气患者中对死亡率、急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）、败血症和肾脏替代治疗（RRT）的预测作用。
我们进行了一项前瞻性、多中心、观察性研究。收集了重症监护的血液样本和数据。纳入了基线时 suPAR 和 PAI-1 测量值的机械通气患者进行分析，并对健康志愿者进行了分析比较。进行了受试者工作特征（ROC）、逻辑回归、似然比和 Kaplan-Meier 分析。
基线时 suPAR 为 11.6ng/ml（四分位数 Q1-Q3，9.6-14.0），而健康志愿者的 suPAR 为 0.6ng/ml（0.5-11.0）。PAI-1 浓度分别为 2.67ng/ml（1.53-4.69）和 0.3ng/ml（0.3-0.4）。suPAR 90 天死亡率的 ROC 分析曲线下面积（AUC）为 0.61（95%置信区间（CI）：0.55-0.67），败血症为 0.68（0.61-0.76），ALI/ARDS 为 0.64（0.56-0.73），RRT 为 0.65（0.56-0.73）。suPAR 浓度最高四分位数的患者 90 天死亡率的优势比为 2.52（1.37-4.64，p=0.003），ALI/ARDS 为 3.16（1.19-8.41，p=0.02）。在非手术患者中，suPAR 的 AUC 为 90 天死亡率 0.61（0.54-0.68），RRT 0.73（0.64-0.83），败血症 0.70（0.60-0.80），ALI/ARDS 0.61（0.51-0.71）。PAI-1 的预测价值可以忽略不计。
在非手术患者中，suPAR 浓度低提示生存，浓度高提示 RRT 和死亡率。suPAR 可用于筛选可能有良好生存机会的患者。与 RRT 的相关性可能为急性肾衰竭提供早期预警信号。
