Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Shock. 2021 Dec 1;56(6):948-955. doi: 10.1097/SHK.0000000000001806.
Hyperfibrinolysis and pro/anti-inflammatory imbalance usually occur in the early stage of severe burns. Soluble urokinase-type plasminogen activator receptor (suPAR) is involved in fibrinolysis and inflammation. To date, the levels of circulating suPAR in non-survivors with severe burns remain unknown. This study aimed to investigate the early association between circulating suPAR levels and biomarkers of fibrinolysis, pro/anti-inflammatory, and prognosis.
Sixty-four consecutive Chinese patients with severe burns and 26 healthy volunteers were enrolled in a prospective observational cohort. Clinical characteristics and laboratory data were collected prospectively. Blood samples were collected at 48 h post-burn, and suPAR and biomarkers of pro/anti-inflammatory and fibrinolysis were detected by enzyme-linked immunosorbent assays. Important indicators between non-survivors and survivors were compared. Linear regression analysis was performed to screen variables associated with suPAR. Logistic regression analysis and receiver operating characteristic curve (ROC) analysis were performed to evaluate the prognostic value of suPAR.
Compared with the control group, the circulating suPAR levels in the survivors (P < 0.001) and non-survivors (P = 0.017) were higher. Compared with survivors, non-survivors had lower circulating suPAR levels at 48 h post-burn, and they showed a higher degree of fibrinolysis (higher D-dimer) and a lower TNF-α/IL-10 ratio. According to linear regression analysis, the variables independently associated with a lower suPAR level were lower platelet factor 4 (PF-4), urokinase-type plasminogen activator (uPA), and TNF-α/IL-10 levels and a higher D-dimer level. Logistic regression and ROC analyses indicated that a suPAR level ≤ 4.70 μg/L was independently associated with 30-day mortality.
Low circulating suPAR levels at 48 h post-burn in severe burn patients may reflect decreased TNF-α/IL-10 ratio and increased hyperfibrinolysis. suPAR can predict 30-day mortality in patients with severe burn.
纤溶亢进和促炎/抗炎失衡通常发生在严重烧伤的早期。可溶性尿激酶型纤溶酶原激活物受体（suPAR）参与纤溶和炎症反应。迄今为止，关于死亡的严重烧伤患者循环 suPAR 水平尚不清楚。本研究旨在探讨循环 suPAR 水平与纤溶、促炎/抗炎和预后标志物的早期相关性。
连续纳入 64 例严重烧伤的中国患者和 26 例健康志愿者，进行前瞻性观察队列研究。前瞻性收集临床特征和实验室数据。在烧伤后 48 小时采集血样，通过酶联免疫吸附试验检测 suPAR 和促炎/抗炎及纤溶标志物。比较非幸存者和幸存者的重要指标。进行线性回归分析筛选与 suPAR 相关的变量。进行逻辑回归分析和受试者工作特征曲线（ROC）分析，评估 suPAR 的预后价值。
与对照组相比，幸存者（P<0.001）和非幸存者（P=0.017）的循环 suPAR 水平较高。与幸存者相比，非幸存者在烧伤后 48 小时的循环 suPAR 水平较低，且纤溶程度较高（D-二聚体较高），TNF-α/IL-10 比值较低。根据线性回归分析，与较低 suPAR 水平独立相关的变量是血小板因子 4（PF-4）、尿激酶型纤溶酶原激活物（uPA）和 TNF-α/IL-10 水平较低，D-二聚体水平较高。逻辑回归和 ROC 分析表明，suPAR 水平≤4.70μg/L 与 30 天死亡率独立相关。
严重烧伤患者烧伤后 48 小时循环 suPAR 水平较低可能反映 TNF-α/IL-10 比值降低和纤溶亢进增加。suPAR 可预测严重烧伤患者 30 天死亡率。
