suPAR 截断值可用于对急诊科低、中、高危急性内科患者进行分层。

suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department.

机构信息

South Savo Social- and Healthcare District, Mikkeli Central Hospital, Mikkeli, Finland.

Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.

出版信息

BMC Emerg Med. 2021 Nov 29;21(1):149. doi: 10.1186/s12873-021-00544-x.

DOI:10.1186/s12873-021-00544-x

PMID:34844557

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8628287/

Abstract

BACKGROUND

Soluble urokinase plasminogen activator receptor (suPAR) levels have previously been associated with readmission and mortality in acute medical patients in the ED. However, no specific cut-offs for suPAR have been tested in this population.

METHODS

Prospective observational study of consecutively included acute medical patients. Follow-up of mortality and readmission was carried out for 30- and 90 days stratified into baseline suPAR < 4, 4-6 and > 6 ng/ml. suPAR levels were measured using suPARnostic® Turbilatex assay on a Cobas c501 (Roche Diagnostics Ltd) analyser.

RESULTS

A total of 1747 acute medical patients in the ED were included. Median age was 70 (IQR: 57-79) and 51.4% were men. Adjusted linear regression analysis showed that suPAR, independently of age, sex and C-reactive protein levels, predicted 30- and 90-day mortality (Odds ratio for doubling in suPAR 1.96 (95% confidence intervals: 1.42-2.70) Among patients with suPAR below 4 ng/ml (N = 804, 46.0%), 8 (1.0%) died within 90-day follow-up, resulting in a negative predictive value of 99.0% and a sensitivity of 94.6%. Altogether 514 (29.4%) patients had suPAR of 4-6 ng/ml, of whom 43 (8.4%) died during 90-day follow-up. Among patients with suPAR above 6 ng/ml (N = 429, 24.6%), 87 patients (20.3%) died within 90-day follow-up, resulting in a positive predictive value of 20.1% and a specificity of 78.7%.

CONCLUSIONS

suPAR cut-offs of below 4, between 4 and 6 and above 6 ng/ml can identify acute medical patients who have low, medium or high risk of 30- and 90-day mortality. The turbidimetric assay provides suPAR results within 30 min that may aid in the decision of discharge or admission of acute medical patients.

摘要

背景

可溶性尿激酶型纤溶酶原激活物受体 (suPAR) 水平先前与急诊急性内科患者的再入院和死亡率相关。然而，在该人群中尚未测试 suPAR 的具体截断值。

方法

对连续纳入的急性内科患者进行前瞻性观察性研究。对 30 天和 90 天的死亡率和再入院进行随访，根据基线 suPAR<4、4-6 和>6ng/ml 进行分层。使用 Cobas c501（罗氏诊断有限公司）分析仪上的 suPARnostic® Turbilatex 测定法测量 suPAR 水平。

结果

共纳入 1747 名急诊内科患者。中位年龄为 70 岁（IQR：57-79），51.4%为男性。调整后的线性回归分析显示，suPAR 可独立于年龄、性别和 C 反应蛋白水平预测 30 天和 90 天的死亡率（suPAR 加倍的优势比为 1.96（95%置信区间：1.42-2.70）。在 suPAR<4ng/ml 的患者中（N=804，46.0%），有 8 例（1.0%）在 90 天随访期间死亡，这使得阴性预测值为 99.0%，敏感性为 94.6%。共有 514 名（29.4%）患者的 suPAR 为 4-6ng/ml，其中 43 名（8.4%）在 90 天随访期间死亡。在 suPAR>6ng/ml 的患者中（N=429，24.6%），有 87 例（20.3%）在 90 天随访期间死亡，阳性预测值为 20.1%，特异性为 78.7%。