title: The predictive value of soluble urokinase plasminogen activator receptor (SuPAR) regarding 90-day mortality and 12-month neurological outcome in critically ill patients after out-of-hospital cardiac arrest. Data from the prospective FINNRESUSCI study.
abstract: OBJECTIVE
  The whole body ischaemia-reperfusion after cardiac arrest (CA) induces a systemic inflammation-reperfusion response. The expression of urokinase plasminogen activator receptor (uPAR) is known to be induced after hypoxia and increased levels of soluble form suPAR have been measured after hypoxia and ischaemia. Our aim was to evaluate, whether ischaemia/reperfusion injury after out-of-hospital cardiac arrest (OHCA) increases suPAR concentrations in serum and to evaluate the prognostic value of suPAR regarding 90-day mortality and 12-month neurological outcome.
  
  
  METHODS
  This is a pre-determined substudy of prospective FINNRESUSCI study. Total of 287 patients treated in the intensive care units after OHCA and with consent from the next-of-kin and serum samples between baseline and day 4 were included. Outcome and neurological outcome were evaluated according the Pittsburgh Cerebral Performance Categories (CPC). Kaplan-Meier survival curves, areas under receiver operational characteristics curves and positive likelihood ratios for mortality and poor neurological outcome were calculated.
  
  
  RESULTS
  Non-survivors had higher levels of suPAR after OHCA. Kaplan-Meier survival curves indicated high 90-day mortality in the highest concentration quintiles. LR+ for 1-year CPC 3-5 was 1.8-2.7 for the whole patient cohort and in shockable rhythms 2.0-2.4. In therapeutic hypothermia prognostic value remained.
  
  
  CONCLUSIONS
  We found that high SuPAR concentrations were associated with poor outcome in patients with OHCA admitted to critical care. However, suPAR alone had inadequate predictive value for poor outcome and did not associate with 12-month neurological outcome.
authors.affiliation: Tampere University Hospital, Critical Care Medicine Research Group, PO Box 2000, 33521 Tampere, Finland. Electronic address: jyrki.tenhunen@surgsci.uu.se.
authors.forename: Ville
authors.initials: V
authors.lastname: Jalkanen
authors.affiliation: Helsinki University Central Hospital, Lohja Hospital, Emergency Department, Sairaalatie 8, 08200 Lohja, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Vaahersalo
authors.affiliation: Helsinki University Hospital, Department of Surgery, Division of Intensive Care Medicine, PO Box 340, 00029 Helsinki University Hospital, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.affiliation: Kuopio University Hospital, Centre for Prehospital Emergency Care, PO Box 100, 70029 Kuopio University Hospital, Finland.
authors.forename: Jouni
authors.initials: J
authors.lastname: Kurola
authors.affiliation: Helsinki University Hospital, Jorvi Hospital, Department of Intensive Care, PO Box 800, 00029 Helsinki University Hospital, Finland.
authors.forename: Tero
authors.initials: T
authors.lastname: Varpula
authors.affiliation: Helsinki University Hospital, Department of Neurology, PO Box 340, 00029 Helsinki University Hospital, Finland.
authors.forename: Marjaana
authors.initials: M
authors.lastname: Tiainen
authors.affiliation: University of Tampere, School of Health Sciences, 33014 University of Tampere, Finland.
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.affiliation: Kanta-Häme Central Hospital, Department of Intensive Care, Ahvenistontie 20, 13530 Hämeenlinna, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Alaspää
authors.affiliation: South-Carelia Central Hospital, Department of Intensive Care, Valto Käkelänkatu 1, 53130 Lappeenranta, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Hovilehto
authors.affiliation: Lapland Central Hospital, Department of Intensive Care, PL 8041, 96101 Rovaniemi, Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Kiviniemi
authors.affiliation: Tampere University Hospital, Critical Care Medicine Research Group, PO Box 2000, 33521 Tampere, Finland.
authors.forename: Anne
authors.initials: A
authors.lastname: Kuitunen
authors.affiliation: Tampere University Hospital, Critical Care Medicine Research Group, PO Box 2000, 33521 Tampere, Finland; Uppsala University Hospital, Department of Surgical Sciences, 75185 Uppsala, Sweden.
authors.forename: Jyrki
authors.initials: J
authors.lastname: Tenhunen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D015427:Reperfusion Injury / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D018570:Risk Assessment; D012720:Severity of Illness Index; D012995:Solubility; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D055293:Receptors, Urokinase Plasminogen Activator
keywords: Biomarkers; OHCA; Out-of-hospital cardiac arrest; Prognostication after cardiac arrest; Resuscitation; Soluble urokinase plasminogen activator receptor (suPAR)