title: Soluble urokinase plasminogen activator receptor (suPAR) for assessment of disease severity in ventilator-associated pneumonia and sepsis.
abstract: Urokinase plasminogen activator (uPAR) is a receptor mainly expressed on peripheral blood mononuclear cells and neutrophils. The role of its soluble form, namely suPAR, as a predictor of sepsis outcome in a homogenous cohort of 180 septic patients, was investigated. Blood from 180 patients with ventilator-associated pneumonia (VAP) and sepsis was collected for seven consecutive days. suPAR and PCT were measured in serum by an enzyme immunoassay and an immuno-time-resolved amplified cryptate assay respectively. Neutrophils and monocytes were isolated on day 1 and incubated. suPAR levels greater than 10.5 ng/ml had 80% specificity and 77.6% positive predictive value to discriminate between severe sepsis and sepsis. suPAR levels greater than 12.9 ng/ml had 80% specificity and 76.1% positive predictive value for prognosis of unfavorable outcome. suPAR levels were significantly lower among survivors than among non-survivors over follow-up. Step-wise Cox regression analysis found suPAR as an independent factor related with unfavorable outcome (p: 0.026). Concentrations of suPAR in supernatants of neutrophils of patients with sepsis were greater compared to controls. It is concluded that suPAR is a reliable marker of sepsis severity and a strong independent predictor of unfavorable outcome in VAP and sepsis. Neutrophils are involved in release.
authors.affiliation: 4th Department of Internal Medicine, ATTIKON University Hospital, 1 Rimini Str, 12462 Athens, Greece. savva.athina@gmail.com
authors.forename: Athina
authors.initials: A
authors.lastname: Savva
authors.forename: Maria
authors.initials: M
authors.lastname: Raftogiannis
authors.forename: Fotini
authors.initials: F
authors.lastname: Baziaka
authors.forename: Christina
authors.initials: C
authors.lastname: Routsi
authors.forename: Anastasia
authors.initials: A
authors.lastname: Antonopoulou
authors.forename: Pantelis
authors.initials: P
authors.lastname: Koutoukas
authors.forename: Thomas
authors.initials: T
authors.lastname: Tsaganos
authors.forename: Anastasia
authors.initials: A
authors.lastname: Kotanidou
authors.forename: Efterpi
authors.initials: E
authors.lastname: Apostolidou
authors.forename: Evangelos J
authors.initials: EJ
authors.lastname: Giamarellos-Bourboulis
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
mesh_terms: D018806:APACHE; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015331:Cohort Studies; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism; D053717:Pneumonia, Ventilator-Associated / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D012720:Severity of Illness Index; D012995:Solubility; D055815:Young Adult
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; D055293:Receptors, Urokinase Plasminogen Activator; D002116:Calcitonin