可溶性尿激酶型纤溶酶原激活物受体和乳酸作为院前以非特异性主诉就诊患者的预后生物标志物——PRIUS 研究。
Soluble urokinase plasminogen activator receptor and lactate as prognostic biomarkers in patients presenting with non-specific chief complaints in the pre-hospital setting - the PRIUS-study.
机构信息
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Academic Emergency Medical Service, Region Stockholm, Stockholm, Sweden.
出版信息
Scand J Trauma Resusc Emerg Med. 2021 Aug 12;29(1):116. doi: 10.1186/s13049-021-00908-z.
BACKGROUND
Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with NSCs often have normal vital signs. It has previously been established that NSCs may have a serious underlying condition that has yet to be identified. The aim of the current study was to determine if soluble urokinase plasminogen activator receptor (suPAR) and lactate could be used to identify serious conditions among patients presenting with NSCs to the EMS. The secondary aim was to describe the prognostic value for mortality in the group.
METHOD
A blinded prospective observational cohort study was conducted of patients brought to the ED by ambulance after calling the national emergency number 112 and who were assessed as having NSC by the EMS. Biomarkers were measured during index EMS assessment before transportation to the ED. Patients were followed via EMS and hospital electronic health records. Descriptive and logistic regression analyses were used.
RESULTS
A total of 414 patients were included, with a median age of 82 years. A serious condition was present in 15.2% of the patients. Elevated suPAR above 3 ng/ml had a positive likelihood ratio (LR+) of 1.17 and a positive predictive value (PPV) of 17.3% as being predictive of a prevalent serious condition. Elevated suPAR above 9 ng/ml had LR+ 4.67 and a PPV of 16.7% as being predictive of 30-day mortality. Lactate was not significantly predictive.
CONCLUSION
Pre-hospital suPAR and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the ED among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment.
TRIAL REGISTRATION
NCT03089359. Registered 20 March 2017, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03089359 .
背景
急救医疗服务（EMS）每天都会遇到出现非特异性主要症状（NSC）的患者。出现 NSC 的患者通常生命体征正常。先前已经确定，NSC 可能存在尚未确定的严重潜在疾病。本研究的目的是确定可溶性尿激酶型纤溶酶原激活物受体（suPAR）和乳酸是否可用于识别 EMS 中出现 NSC 的患者的严重疾病。次要目的是描述该组的死亡率预后价值。
方法
对通过拨打国家紧急号码 112 并由救护车送往急诊室的患者进行了一项盲前瞻性观察队列研究，该研究由 EMS 评估为出现 NSC。在送往 ED 之前，在指数 EMS 评估期间测量生物标志物。通过 EMS 和医院电子健康记录对患者进行随访。使用描述性和逻辑回归分析。
结果
共纳入 414 例患者，中位年龄为 82 岁。15.2%的患者存在严重疾病。suPAR 高于 3ng/ml 时，阳性似然比（LR+）为 1.17，阳性预测值（PPV）为 17.3%，提示存在普遍严重疾病。suPAR 高于 9ng/ml 时，LR+为 4.67，PPV 为 16.7%，提示 30 天死亡率。乳酸无显著预测性。
结论
在出现非特异性主要症状的患者中，院前 suPAR 和乳酸不能区分需要紧急治疗和 ED 评估的严重疾病。suPAR 已被证明可预测 30 天死亡率，这可能为临床评估增加一些价值。
试验注册
NCT03089359。于 2017 年 3 月 20 日注册，回顾性注册，https://clinicaltrials.gov/ct2/show/NCT03089359。
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