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

• Published in: Resuscitation Vol. 85; no. 11; pp. 1562 - 1567
• Main Authors: Jalkanen, Ville, Vaahersalo, Jukka, Pettilä, Ville, Kurola, Jouni, Varpula, Tero, Tiainen, Marjaana, Huhtala, Heini, Alaspää, Ari, Hovilehto, Seppo, Kiviniemi, Outi, Kuitunen, Anne, Tenhunen, Jyrki
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.11.2014
• Subjects: Aged; Biomarkers; Biomarkers - blood; Cardiopulmonary Resuscitation - adverse effects; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - mortality; Critical Illness - mortality; Critical Illness - therapy; Databases, Factual; Emergency; Female; Hospital Mortality - trends; Humans; Hypothermia, Induced - adverse effects; Hypothermia, Induced - methods; Intensive Care Units; Kaplan-Meier Estimate; Male; Middle Aged; Nervous System Diseases - epidemiology; Nervous System Diseases - etiology; Nervous System Diseases - physiopathology; OHCA; Out-of-hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Predictive Value of Tests; Prognosis; Prognostication after cardiac arrest; Prospective Studies; Receptors, Urokinase Plasminogen Activator - blood; Reperfusion Injury - blood; Reperfusion Injury - etiology; Reperfusion Injury - physiopathology; Resuscitation; Risk Assessment; ROC Curve; Severity of Illness Index; Solubility; Soluble urokinase plasminogen activator receptor (suPAR); Survival Analysis; Systemic Inflammatory Response Syndrome - blood; Systemic Inflammatory Response Syndrome - etiology; Systemic Inflammatory Response Syndrome - physiopathology; Time Factors; Treatment Outcome; Biomarkers; Out-of-hospital cardiac arrest; Soluble urokinase plasminogen activator receptor (suPAR); OHCA; Resuscitation; Prognostication after cardiac arrest
• ISSN: 0300-9572; 1873-1570; 1873-1570
• DOI: 10.1016/j.resuscitation.2014.08.017

Abstract Aim 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.