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Abstract
Objective 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.
Methods 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.
Results 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.
Conclusions 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.
- risk management
- acute care
- clinical assessment
- triage
- emergency department
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Supplementary materials
Abstract in Danish
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- Abstract in Danish - Online abstract
Footnotes
Contributors LJHR, SL, THH, JE-O and OA conceived and coordinated the investigation. LJHR and SL performed the statistical analyses. LJHR, SL, THH, JE-O and OA interpreted the data. LJHR, SL, THH, JE-O and OA drafted the manuscript. LJHR, SL, THH, GE, JHP, KI, JE-O and OA contributed to the discussion and reviewed and edited the article. LJHR is the guarantor of the study.
Funding This study received no external funding, but LJHR is supported by a grant from the Lundbeck Foundation (grant no. R180-2014-3360).
Competing interests LJHR has received funding for travel from ViroGates A/S, Denmark, the company that produces the suPARnostic assays. JE-O and OA are named inventors on patents on suPAR and prognosis. The patents are owned by Copenhagen University Hospital Hvidovre, Denmark, and licensed to ViroGates A/S. JE-O is a co-founder, shareholder and CSO of ViroGates A/S.
Ethics approval This registry-based 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).
Provenance and peer review Not commissioned; externally peer reviewed.