Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650, Hvidovre, Denmark.
Department of Cardiology, Copenhagen University Hospital Herlev, 2730, Herlev, Denmark.
Scand J Trauma Resusc Emerg Med. 2018 Feb 1;26(1):11. doi: 10.1186/s13049-018-0478-1.
BACKGROUND: Acutely admitted medical patients are often fragile and in risk of future surgery. The biomarker soluble urokinase plasminogen activator receptor (suPAR) is a predictor of readmission and mortality in the acute care setting. We aimed to investigate if suPAR also predicts acute surgery, which is associated with higher mortality than elective surgery, and if it predicts post-operative mortality. METHODS: A retrospective registry-based cohort study of 17,312 patients admitted to an acute medical unit in Denmark, from 18 November 2013 until 30 September 2015. The first admission with available suPAR was defined as the index admission, and patients were followed via national registries until 1 January 2016. The risk of acute surgery during the entire follow-up period as well as the 90-day post-operative mortality risk was modeled by Cox regression analyses adjusted for sex, age, C-reactive protein, and Charlson Comorbidity Index (Charlson Score). RESULTS: Acute surgery was carried out on 2404 patients (13.9%) after a median of 45 days (interquartile range 5-186) following the index admission. Patients receiving acute surgery had higher baseline suPAR compared with patients receiving elective- or no surgery (p < 0.0001). The hazard ratio (HR) for acute surgery was 1.50 (95% confidence interval (CI): 1.42-1.59) for every doubling of the suPAR level in the adjusted Cox regression analysis. Death within 90 days occurred in 439 (18.3%) patients receiving acute surgery, and the adjusted HR for post-operative mortality was 1.73 (95% CI: 1.52-1.95). DISCUSSION: Elevated levels of suPAR in acutely admitted medical patients were independently associated with increased risk of future acute surgery as well as with 90-day post-operative mortality. TRIAL REGISTRATION: This retrospective registry-based cohort study was approved by the Danish Health and Medicines authority (reference no. 3-3013-1061/1). All processing of personal data followed national guidelines, and the project was approved by the Danish Data Protection Agency (reference no. HVH-2014-018, 02767).
背景：急性入院的患者通常身体脆弱，存在未来手术的风险。生物标志物可溶性尿激酶型纤溶酶原激活物受体（suPAR）是急性护理环境中再入院和死亡率的预测因子。我们旨在研究 suPAR 是否也可预测急性手术，与择期手术相比，急性手术的死亡率更高，以及是否可预测术后死亡率。
方法：这是一项在丹麦急性医学病房进行的回顾性基于登记的队列研究，研究对象为 2013 年 11 月 18 日至 2015 年 9 月 30 日期间入院的 17312 名患者。第一次有 suPAR 检测结果的入院被定义为指数入院，通过国家登记册对患者进行随访，随访时间截至 2016 年 1 月 1 日。通过 Cox 回归分析，调整性别、年龄、C 反应蛋白和 Charlson 合并症指数（Charlson 评分）后，对整个随访期间急性手术的风险和术后 90 天内的死亡率风险进行建模。
结果：指数入院后中位数 45 天（5-186 天）内，2404 名（13.9%）患者接受了急性手术。与接受择期手术或无手术的患者相比，接受急性手术的患者基线 suPAR 水平更高（p<0.0001）。在调整后的 Cox 回归分析中，suPAR 水平每增加一倍，发生急性手术的风险比（HR）为 1.50（95%置信区间（CI）：1.42-1.59）。接受急性手术的患者中，90 天内死亡的患者有 439 人（18.3%），术后死亡率的调整 HR 为 1.73（95%CI：1.52-1.95）。
讨论：急性入院的患者 suPAR 水平升高与未来急性手术风险增加以及术后 90 天死亡率升高独立相关。
试验注册：这项回顾性基于登记的队列研究得到了丹麦卫生和药品管理局的批准（注册号 3-3013-1061/1）。所有个人数据的处理均遵循国家准则，该项目还得到了丹麦数据保护局的批准（注册号 HVH-2014-018、02767）。
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