Plasma level of soluble urokinase‐type plasminogen activator receptor as a predictor of disease severity and case fatality in patients with bacteraemia: a prospective cohort study

• Published in: Journal of internal medicine Vol. 270; no. 1; pp. 32 - 40
• Main Authors: Huttunen, R., Syrjänen, J., Vuento, R., Hurme, M., Huhtala, H., Laine, J., Pessi, T., Aittoniemi, J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2011; Blackwell
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; bacteraemia; Bacteremia; Bacteremia - diagnosis; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; biomarker; biomarkers; Biomarkers - blood; Blood culture; Blood pressure; Endothelial cells; Enzyme-linked immunosorbent assay; Epidemiologic Methods; Escherichia coli; Female; General aspects; Human bacterial diseases; Humans; Hypotension; Infectious diseases; Inflammation; Male; Medical sciences; Middle Aged; Miscellaneous; outcome; Plasma levels; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Receptors, Urokinase Plasminogen Activator - blood; Regression analysis; Risk factors; sepsis; soluble urokinase‐type plasminogen activator receptor; Staphylococcus aureus; Streptococcus pneumoniae; suPAR; u-Plasminogen activator; Young Adult; u-Plasminogen activator; Biological marker; Soluble form; Blood plasma; Prospective; Sepsis syndrome; suPAR; Cohort study; Evolution; Public health; outcome; Biological receptor; Human; Serine endopeptidases; Enzyme; Mortality; bacteraemia; Biological indicator; Patient; biomarker; Bacteremia; Infection; Peptidases; Bacteriosis; Phenotype variation; soluble urokinase-type plasminogen activator receptor; Hydrolases; Death; Predictive factor; sepsis
• ISSN: 0954-6820; 1365-2796; 1365-2796
• DOI: 10.1111/j.1365-2796.2011.02363.x

Huttunen R, Syrjänen J, Vuento R, Hurme M, Huhtala H, Laine J, Pessi T, Aittoniemi J (Tampere University Hospital; University of Tampere Medical School, University of Tampere; Centre for Laboratory Medicine, Pirkanmaa Hospital District; University of Tampere Medical School; School of Health Sciences, University of Tampere; and Medical School, University of Tampere; Tampere, Finland) Plasma level of soluble urokinase‐type plasminogen activator receptor as a predictor of disease severity and case fatality in patients with bacteraemia: a prospective cohort study. J Intern Med 2011; 270: 32–40. .  Objectives.  Urokinase‐type plasminogen activator receptor (uPAR) is expressed on a variety of different immune cells and vascular endothelial cells during inflammation. Previous studies indicate that a high plasma concentration of the soluble form of the receptor (suPAR) predicts poor outcome in infectious diseases. Design.  A prospective cohort study. Subjects and methods.  Plasma suPAR levels were measured in 132 patients with bacteraemia caused by Staphylococcus aureus, Streptococcus pneumoniae, ß‐haemolytic streptococcae or Escherichia coli using a commercial enzyme‐linked immunosorbent assay (ELISA). Values were measured on days 1–4 after a positive blood culture, on days 13–18 and on recovery. Results.  The maximum suPAR values on days 1–4 were markedly higher in nonsurvivors compared to survivors (15.8 vs. 7.3 ng mL−1, P < 0.001) and the area under the receiver operating characteristic curve (AUCROC) in the prediction of case fatality was 0.84 (95% confidence interval (CI) 0.76–0.93, P < 0.001). At a cut‐off level of 11.0 ng mL−1, the sensitivity and specificity of suPAR for fatal disease was 83% and 76%, respectively. A high level of suPAR (≥11 ng mL−1) was associated with hypotension (mean arterial pressure <70 mmHg) (odds ratio (OR) 6.5; 95% CI 2.9–14.6) and high sequential organ failure assessment score (≥4) (OR 9.3; 95% CI 4.0–21.9). A high suPAR level remained an independent risk factor for case fatality in a logistic regression model adjusted for potential confounders. Conclusion.  Plasma suPAR level is a sensitive and specific independent prognostic biomarker in patients with bacteraemia.