title: Diagnostic accuracy of soluble urokinase plasminogen activator receptor (suPAR) for prediction of bacteremia in patients with systemic inflammatory response syndrome.
abstract: OBJECTIVE
  Soluble urokinase plasminogen activator receptor (suPAR) serum concentrations have recently been described to reflect the severity status of systemic inflammation. In this study, the diagnostic accuracy of suPAR, C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) to predict bacteremia in patients with systemic inflammatory response syndrome (SIRS) was compared.
  
  
  METHODS
  A total of 132 patients with SIRS were included. In 55 patients blood cultures had resulted positive (study group 1, Gram positive bacteria: Staphylococcus aureus and Streptococcus spp., n=15; study group 2, Gram-negative bacteria, n=40) and 77 patients had negative blood culture results (control group, n=77). Simultaneously with blood cultures suPAR, CRP, PCT, IL-6 and white blood count (WBC) were determined.
  
  
  RESULTS
  SuPAR values were significantly higher in study group 1 (median 8.11; IQR 5.78-15.53; p=0.006) and study group 2 (median 9.62; IQR 6.52-11.74; p<0.001) when compared with the control group (median 5.65; IQR 4.30-7.83). ROC curve analysis revealed an AUC of 0.726 for suPAR in differentiating SIRS patients with bacteremia from those without. The biomarkers PCT and IL-6 showed comparable results. Regarding combinations of biomarkers multiplying suPAR, PCT and IL-6 was most promising and resulted in an AUC value of 0.804. Initial suPAR serum concentrations were significantly higher (p=0.028) in patients who died within 28 days than in those who survived. No significant difference was seen for PCT, IL-6 and CRP.
  
  
  CONCLUSIONS
  In conclusion, suPAR, IL-6 and PCT may contribute to predicting bacteremia in SIRS patients.
authors.affiliation: Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 20, 8036 Graz, Austria. martin.hoenigl@medunigraz.at
authors.forename: Martin
authors.initials: M
authors.lastname: Hoenigl
authors.forename: Reinhard B
authors.initials: RB
authors.lastname: Raggam
authors.forename: Jasmin
authors.initials: J
authors.lastname: Wagner
authors.forename: Thomas
authors.initials: T
authors.lastname: Valentin
authors.forename: Eva
authors.initials: E
authors.lastname: Leitner
authors.forename: Katharina
authors.initials: K
authors.lastname: Seeber
authors.forename: Ines
authors.initials: I
authors.lastname: Zollner-Schwetz
authors.forename: Werner
authors.initials: W
authors.lastname: Krammer
authors.forename: Florian
authors.initials: F
authors.lastname: Prüller
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Grisold
authors.forename: Robert
authors.initials: R
authors.lastname: Krause
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016470:Bacteremia / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D016022:Case-Control Studies; D004926:Escherichia coli / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology / Q000473:pathology; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000473:pathology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007709:Klebsiella / Q000302:isolation & purification / Q000472:pathogenicity; D007958:Leukocyte Count / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000472:pathogenicity; D018746:Systemic Inflammatory Response Syndrome / Q000382:microbiology / Q000473:pathology*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D015850:Interleukin-6; D011498:Protein Precursors; D055293:Receptors, Urokinase Plasminogen Activator; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide