suPARnostic^® as a treatment efficacy monitoring tool in systemic inflammatory response syndrome/sepsis patients

Background

Biomarkers may aid in risk triaging of systemic inflammatory response syndrome (SIRS) patients at admittance to hospital and in the monitoring of response to medical intervention. The overall aim is reducing mortality in SIRS and sepsis patients.

Methods

A prospectively collected cohort of patients with SIRS that were admitted to an emergency department and a department of infectious diseases at a Copenhagen University hospital were studied. Samples obtained daily during hospitalization were measured for soluble urokinase plasminogen activator receptor (suPAR) using the CE/IVD-approved (the product complies with the European Directives for In-Vitro Diagnostics) suPARnostic^® assay and were compared with various other clinical parameters associated with assessing disease severity, including C-reactive protein, procalcitonin, Simplified Acute Physiology Score II, and Sepsis-related Organ Failure Assessment scores. Survival was assessed using receiver operating curve statistics.

Results

One hundred and fifty-one patients were included in the study, nine of whom died within 30 days of admission. Admission levels of suPAR were higher among non-survivors compared to survivors with an area under the curve of 0.80 and 0.92 when combined with age. Admission levels of procalcitonin and C-reactive protein were not significantly different between survivors and nonsurvivors. Simplified Acute Physiology Score II and Sepsis-related Organ Failure Assessment scores were significant predictors of death in this setting as well. During treatment, survivors showed overall declining suPAR levels (Figure 1) while continuously elevated suPAR levels were observed in nonsurvivors (Figure 2).

Figure 1

suPAR levels among surviving SIRS patients during treatment. Dotted line, mean suPAR among patients with an inclusion suPAR >5 ng/ml (n = 50). Dashed line, suPAR levels among patients with an inclusion suPAR <5 ng/ml (n = 68).

Figure 2

suPAR levels among patients who either had severe complications (n = 14) or died (n = 9) within 30 days of hospitalization. Dotted line, mean suPAR for the 23 patients.

Conclusion

The suPARnostic^® assay provided significant information on risk of mortality following admission. Continuous elevated suPAR levels during treatment were associated with poor clinical outcome.