Rasmussen Line Jee Hartmann, Ladelund Steen, Haupt Thomas Huneck, Ellekilde Gertrude, Poulsen Jørgen Hjelm, Iversen Kasper, Eugen-Olsen Jesper, Andersen Ove
Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Copenhagen, Denmark.
Acute Medical Department, Copenhagen University Hospital Hvidovre, Hvidovre, Copenhagen, Denmark.
Emerg Med J. 2016 Nov;33(11):769-775. doi: 10.1136/emermed-2015-205444. Epub 2016 Sep 2.
Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker associated with presence and progression of disease and with increased risk of mortality. We aimed to evaluate the unspecific biomarker suPAR as a prognostic marker in patients admitted to acute care.
This registry-based retrospective cohort study included 4343 consecutively admitted patients from the Acute Medical Unit at a large Danish university hospital. Time to readmission and death were analysed by multiple Cox regression. Results were reported as HRs for 30-day and 90-day follow-up.
During 30-day follow-up, 782 patients (18.0%) were readmitted and 224 patients (5.2%) died. Comparing 30-day readmission and mortality between patients in the highest and lowest suPAR quartiles yielded HRs of 2.11 (95% CI 1.70 to 2.62) and 4.11 (95% CI 2.46 to 6.85), respectively, when adjusting for age, sex, Charlson score and C reactive protein. Area under the curve for receiver operating characteristics curve analysis of suPAR for 30-day mortality was 0.84 (95% CI 0.81 to 0.86). Furthermore, in the entire cohort, women had slightly higher suPAR compared with men, and suPAR was associated with age, admission time, admission to intensive care unit and Charlson score.
In this large unselected population of acute medical patients, suPAR is strongly associated with disease severity, readmission and mortality after adjusting for all other risk factors, indicating that suPAR adds information to established prognostic indicators. While patients with low suPAR levels have low risk of readmission and mortality, patients with high suPAR levels have a high risk of adverse events.
可溶性尿激酶型纤溶酶原激活物受体（suPAR）是一种炎症生物标志物，与疾病的存在和进展以及死亡风险增加相关。我们旨在评估非特异性生物标志物suPAR作为急性护理入院患者预后标志物的价值。
这项基于登记的回顾性队列研究纳入了丹麦一家大型大学医院急性内科连续收治的4343例患者。通过多因素Cox回归分析再入院时间和死亡时间。结果以30天和90天随访的风险比（HR）报告。
在30天随访期间，782例患者（18.0%）再次入院，224例患者（5.2%）死亡。在调整年龄、性别、Charlson评分和C反应蛋白后，比较最高和最低suPAR四分位数患者的30天再入院率和死亡率，HR分别为2.11（95%CI 1.70至2.62）和4.11（95%CI 2.46至6.85）。suPAR对30天死亡率的受试者工作特征曲线分析的曲线下面积为0.84（95%CI 0.81至0.86）。此外，在整个队列中，女性的suPAR略高于男性，且suPAR与年龄、入院时间、入住重症监护病房和Charlson评分相关。
在这个未经过选择的大型急性内科患者群体中，在调整所有其他风险因素后，suPAR与疾病严重程度、再入院和死亡率密切相关，这表明suPAR为既定的预后指标增加了信息。suPAR水平低的患者再入院和死亡风险低，而suPAR水平高的患者发生不良事件的风险高。
