title: Soluble urokinase plasminogen activator receptor predicts mortality in patients with systemic inflammatory response syndrome.
abstract: OBJECTIVE
  The soluble urokinase plasminogen activator receptor (suPAR) reflects inflammation. However, the prognostic value of suPAR measurements, particularly at the very early onset of systemic inflammatory response syndrome (SIRS), is less well defined.
  
  
  METHODS
  The prognostic potential of suPAR levels in patients with SIRS was evaluated. From November 2010 until April 2013, 902 adult patients presenting with SIRS were investigated. Blood samples for laboratory testing of inflammation markers were collected simultaneously with initial blood cultures. suPAR testing was performed using suPARnostic(©) assay.
  
  
  RESULTS
  Analyses of receiver operating characteristics curves revealed areas under the curve (AUCs) of 0.818 for predicting overall mortality within 48 h (36/902 patients died), 0.739 for 30-day mortality (117/902 died) and 0.706 for predicting 90-day mortality (151/902 died). AUCs for procalcitonin (0.777, 0.671 and 0.638), interleukin-6 (0.709, 0.593 and 0.569) and C-reactive protein (0.66, 0.594 and 0.586) as well as renal function and age were markedly lower. Using multivariable regression analyses, suPAR levels (P < 0.001) remained significant predictors of 48-h mortality, whereas suPAR levels (P < 0.001) and bacteraemia (P = 0.002 and P = 0.001, respectively) remained significant predictors of 30- and 90-day mortality. Using Kaplan-Meier survival plots, patients with suPAR <9.15 ng mL(-1) at SIRS onset had a clear benefit.
  
  
  CONCLUSIONS
  suPAR plasma level determined at early SIRS is predictive for mortality.
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
authors.forename: R B
authors.initials: RB
authors.lastname: Raggam
authors.forename: J
authors.initials: J
authors.lastname: Wagner
authors.forename: F
authors.initials: F
authors.lastname: Prüller
authors.forename: A
authors.initials: A
authors.lastname: Grisold
authors.forename: E
authors.initials: E
authors.lastname: Leitner
authors.forename: I
authors.initials: I
authors.lastname: Zollner-Schwetz
authors.forename: T
authors.initials: T
authors.lastname: Valentin
authors.forename: R
authors.initials: R
authors.lastname: Krause
authors.forename: M
authors.initials: M
authors.lastname: Hoenigl
mesh_terms: D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D003404:Creatinine / Q000097:blood; D005260:Female; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D012044:Regression Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000401:mortality*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D006023:Glycoproteins; D015850:Interleukin-6; D011498:Protein Precursors; D055293:Receptors, Urokinase Plasminogen Activator; D002116:Calcitonin; D002097:C-Reactive Protein; D003404:Creatinine; D015740:Calcitonin Gene-Related Peptide
keywords: laboratory biomarker; mortality, prediction; soluble urokinase plasminogen activator receptor; systemic inflammatory response syndrome