title: Plasma level of soluble urokinase-type plasminogen activator receptor as a predictor of disease severity and case fatality in patients with bacteraemia: a prospective cohort study.
abstract: OBJECTIVE
  Urokinase-type plasminogen activator receptor (uPAR) is expressed on a variety of different immune cells and vascular endothelial cells during inflammation. Previous studies indicate that a high plasma concentration of the soluble form of the receptor (suPAR) predicts poor outcome in infectious diseases.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Plasma suPAR levels were measured in 132 patients with bacteraemia caused by Staphylococcus aureus, Streptococcus pneumoniae, ß-haemolytic streptococcae or Escherichia coli using a commercial enzyme-linked immunosorbent assay (ELISA). Values were measured on days 1-4 after a positive blood culture, on days 13-18 and on recovery.
  
  
  RESULTS
  The maximum suPAR values on days 1-4 were markedly higher in nonsurvivors compared to survivors (15.8 vs. 7.3 ng mL(-1) , P < 0.001) and the area under the receiver operating characteristic curve (AUC(ROC) ) in the prediction of case fatality was 0.84 (95% confidence interval (CI) 0.76-0.93, P < 0.001). At a cut-off level of 11.0 ng mL(-1) , the sensitivity and specificity of suPAR for fatal disease was 83% and 76%, respectively. A high level of suPAR (≥ 11 ng mL(-1) ) was associated with hypotension (mean arterial pressure < 70 mmHg) (odds ratio (OR) 6.5; 95% CI 2.9-14.6) and high sequential organ failure assessment score (≥ 4) (OR 9.3; 95% CI 4.0-21.9). A high suPAR level remained an independent risk factor for case fatality in a logistic regression model adjusted for potential confounders.
  
  
  CONCLUSIONS
  Plasma suPAR level is a sensitive and specific independent prognostic biomarker in patients with bacteraemia.
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, University of Tampere Medical School, University of Tampere, Tampere, Finland. reetta.huttunen@uta.fi
authors.forename: R
authors.initials: R
authors.lastname: Huttunen
authors.forename: J
authors.initials: J
authors.lastname: Syrjänen
authors.forename: R
authors.initials: R
authors.lastname: Vuento
authors.forename: M
authors.initials: M
authors.lastname: Hurme
authors.forename: H
authors.initials: H
authors.lastname: Huhtala
authors.forename: J
authors.initials: J
authors.lastname: Laine
authors.forename: T
authors.initials: T
authors.lastname: Pessi
authors.forename: J
authors.initials: J
authors.lastname: Aittoniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D055293:Receptors, Urokinase Plasminogen Activator