title: Soluble urokinase-type plasminogen activator receptor in patients with suspected infection in the emergency room: a prospective cohort study.
abstract: OBJECTIVE
  The soluble form of urokinase-type plasminogen activator (suPAR) was evaluated as an early prognostic marker of sepsis in patients with suspected infection.
  
  
  METHODS
  A single-centre prospective cohort study.
  
  
  METHODS
  The cohort comprised 539 patients in the emergency department with suspected infection: 59 without systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 68 with bacterial infection and without SIRS (group 2), 54 with SIRS and without bacterial infection (group 3), 309 with sepsis (SIRS and bacterial infection) and without organ failure (group 4) and 49 with severe sepsis (SIRS, bacterial infection and organ failure) (group 5). suPAR was measured on admission using a commercial solid-phase enzyme-linked immunosorbent assay.
  
  
  RESULTS
  The median soluble form of the receptor (suPAR) concentrations in groups 1-5 were 4.7, 5.0, 4.4, 4.8 and 7.9 ng mL(-1) , respectively (P < 0.001). The levels were significantly higher in nonsurvivors compared with survivors (8.3 vs. 4.9 ng mL(-1) , P < 0.001) and in patients with severe sepsis (group 5) compared with those in the other groups (7.9 vs. 4.8 ng mL(-1) , P < 0.001). Area under the receiver operating characteristics curve (AUC(ROC) ) for the prediction of case fatality was 0.79 (95% confidence interval [CI]: 0.72-0.86, P < 0.0001) and 0.75 for severe sepsis (95% CI: 0.68-0.81, P < 0.0001). At a cut-off level of 6.4 ng mL(-1) , suPAR had 76% sensitivity and 69% specificity for fatal disease; at a cut-off level of 6.6 ng mL(-1) , the sensitivity and specificity for severe sepsis were 67% and 72%, respectively. In multivariate models, high suPAR remained an independent predictor of case fatality and severe sepsis after adjusting for potential confounders.
  
  
  CONCLUSIONS
  A high suPAR level predicts case fatality and severe sepsis in patients with suspected infection.
authors: Department of Infectious Diseases, Satakunta Central Hospital, Pori, Finland. raija.uusitalo-seppala@satadiag.fi
authors: R
authors: R
authors: Uusitalo-Seppälä
authors: R
authors: R
authors: Huttunen
authors: M
authors: M
authors: Tarkka
authors: J
authors: J
authors: Aittoniemi
authors: P
authors: P
authors: Koskinen
authors: A
authors: A
authors: Leino
authors: T
authors: T
authors: Vahlberg
authors: E M
authors: EM
authors: Rintala
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D004636:Emergency Service, Hospital; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D014568:Urokinase-Type Plasminogen Activator / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D011498:Protein Precursors; D002116:Calcitonin; D014568:Urokinase-Type Plasminogen Activator