title: Plasma suPAR as a prognostic biological marker for ICU mortality in ARDS patients.
abstract: OBJECTIVE
  We investigated the prognostic value of plasma soluble urokinase plasminogen activator receptor (suPAR) on day 1 in patients with the acute respiratory distress syndrome (ARDS) for intensive care unit (ICU) mortality and compared it with established disease severity scores on day 1.
  
  
  METHODS
  suPAR was determined batchwise in plasma obtained within 24 h after admission.
  
  
  RESULTS
  632 ARDS patients were included. Significantly (P = 0.02) higher median levels of suPAR were found with increasing severity of ARDS: 5.9 ng/ml [IQR 3.1-12.8] in mild ARDS (n = 82), 8.4 ng/ml [IQR 4.1-15.0] in moderate ARDS (n = 333), and 9.0 ng/ml [IQR 4.5-16.0] in severe ARDS (n = 217). Non-survivors had higher median levels of suPAR [12.5 ng/ml (IQR 5.1-19.5) vs. 7.4 ng/ml (3.9-13.6), P < 0.001]. The area under the receiver operator characteristic curve (ROC-AUC) for mortality of suPAR (0.62) was lower than the ROC-AUC of the APACHE IV score (0.72, P = 0.007), higher than that of the ARDS definition classification (0.53, P = 0.005), and did not differ from that of the SOFA score (0.68, P = 0.07) and the oxygenation index (OI) (0.58, P = 0.29). Plasma suPAR did not improve the discrimination of the established disease severity scores, but did improve net reclassification of the APACHE score (29%), SOFA score (23%), OI (38%), and Berlin definition classification (39%).
  
  
  CONCLUSIONS
  As a single biological marker, the prognostic value for death of plasma suPAR in ARDS patients is low. Plasma suPAR, however, improves the net reclassification, suggesting a potential role for suPAR in ICU mortality prediction models.
authors.affiliation: Department of Intensive Care, Academic Medical Center, Meibergdreef 9, G3-228, 1105 AZ, Amsterdam, The Netherlands, diederikgeboers@gmail.com.
authors.forename: Diederik G P J
authors.initials: DG
authors.lastname: Geboers
authors.forename: Friso M
authors.initials: FM
authors.lastname: de Beer
authors.forename: Anita M
authors.initials: AM
authors.lastname: Tuip-de Boer
authors.forename: Tom
authors.initials: T
authors.lastname: van der Poll
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.forename: Olaf L
authors.initials: OL
authors.lastname: Cremer
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
authors.forename: David S Y
authors.initials: DS
authors.lastname: Ong
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Lieuwe D J
authors.initials: LD
authors.lastname: Bos
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000145:classification / Q000401:mortality*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D055293:Receptors, Urokinase Plasminogen Activator