title: Plasma suPAR levels are associated with mortality, admission time, and Charlson Comorbidity Index in the acutely admitted medical patient: a prospective observational study.
abstract: BACKGROUND
  Soluble urokinase plasminogen activator receptor (suPAR) is the soluble form of the membrane-bound receptor (uPAR) expressed predominantly on various immune cells. Elevated plasma suPAR concentration is associated with increased mortality in various patient groups, and it is speculated that suPAR is a low-grade inflammation marker reflecting on disease severity. The aim of this prospective observational study was to determine if the plasma concentration of suPAR is associated with admission time, re-admission, disease severity/Charlson Comorbidity Index Score, and mortality.
  
  
  METHODS
  We included 543 patients with various diseases from a Danish Acute Medical Unit during a two month period. A triage unit ensured that only medical patients were admitted to the Acute Medical Unit. SuPAR was measured on plasma samples drawn upon admission. Patients were followed-up for three months after inclusion by their unique civil registry number and using Danish registries to determine admission times, readmissions, International Classification of Diseases, 10th Edition (ICD-10) diagnoses, and mortality. Statistical analysis was used to determine suPAR's association with these endpoints.
  
  
  RESULTS
  Increased suPAR was significantly associated with 90-day mortality (4.87 ng/ml in survivors versus 7.29 ng/ml in non-survivors, P < 0.0001), higher Charlson Score (P < 0.0001), and longer admission time (P < 0.0001), but not with readmissions. The association with mortality remained when adjusting for age, sex, C-reactive protein (CRP), and Charlson Score. Furthermore, among the various Charlson Score disease groups, suPAR was significantly higher in those with diabetes, cancer, cardiovascular disease, and liver disease compared to those without comorbidities.
  
  
  CONCLUSIONS
  SuPAR is a marker of disease severity, admission time, and risk of mortality in a heterogeneous cohort of patients with a variety of diseases. The independent value of suPAR suggests it could be of value in prognostic algorithms.
authors: Thomas Huneck
authors: TH
authors: Haupt
authors: Janne
authors: J
authors: Petersen
authors: Gertrude
authors: G
authors: Ellekilde
authors: Henrik Hedegaard
authors: HH
authors: Klausen
authors: Christian Wandall
authors: CW
authors: Thorball
authors: Jesper
authors: J
authors: Eugen-Olsen
authors: Ove
authors: O
authors: Andersen
mesh_terms: D000208:Acute Disease / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D012042:Registries; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers; D055293:Receptors, Urokinase Plasminogen Activator