Soluble Urokinase Plasminogen Activator Receptor and Lactate As Prognostic Biomarkers in Patients Presenting with Non-specific Chief Complaints in the Pre-hospital Setting - the PRIUS-study

Overview

Journal Scand J Trauma Resusc Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2021 Aug 13

PMID 34384460

Citations 4

Authors

Robert Ivic

Jouni Nurmi

Lisa Kurland

Veronica Vicente

Veronica Lindstrom

Therese Djarv

Johanna Kaartinen

Maaret Castren

Katarina Bohm

Affiliations

Soon will be listed here.

Abstract

Background: Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with NSCs often have normal vital signs. It has previously been established that NSCs may have a serious underlying condition that has yet to be identified. The aim of the current study was to determine if soluble urokinase plasminogen activator receptor (suPAR) and lactate could be used to identify serious conditions among patients presenting with NSCs to the EMS. The secondary aim was to describe the prognostic value for mortality in the group.

Method: A blinded prospective observational cohort study was conducted of patients brought to the ED by ambulance after calling the national emergency number 112 and who were assessed as having NSC by the EMS. Biomarkers were measured during index EMS assessment before transportation to the ED. Patients were followed via EMS and hospital electronic health records. Descriptive and logistic regression analyses were used.

Results: A total of 414 patients were included, with a median age of 82 years. A serious condition was present in 15.2% of the patients. Elevated suPAR above 3 ng/ml had a positive likelihood ratio (LR+) of 1.17 and a positive predictive value (PPV) of 17.3% as being predictive of a prevalent serious condition. Elevated suPAR above 9 ng/ml had LR+ 4.67 and a PPV of 16.7% as being predictive of 30-day mortality. Lactate was not significantly predictive.

Conclusion: Pre-hospital suPAR and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the ED among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment.

Trial Registration: NCT03089359. Registered 20 March 2017, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03089359 .

Citing Articles

The use and impact of prehospital blood lactate measurements in acute non-traumatic patients: a systematic review.

Walther L, Mieritz H, Lassen A, Christensen E, Mogensen C, Mikkelsen S Scand J Trauma Resusc Emerg Med. 2024; 32(1):137.

PMID: 39725991 PMC: 11670429. DOI: 10.1186/s13049-024-01310-1.

Serious conditions among conveyed and non-conveyed patients presenting with nonspecific chief complaints to the ambulance service.

Ivic-Moren R, Bohm K, Vicente V, Arvidsson E, Castren M, Kurland L BMC Emerg Med. 2024; 24(1):199.

PMID: 39443901 PMC: 11515605. DOI: 10.1186/s12873-024-01106-7.

Added predictive value of prehospital measurement of point-of-care lactate in an adult general EMS population in Sweden: a multi-centre observational study.

Magnusson C, Herlitz J, Axelsson C, Hoglind R, Lokholm E, Hornfeldt T Scand J Trauma Resusc Emerg Med. 2024; 32(1):72.

PMID: 39164765 PMC: 11337621. DOI: 10.1186/s13049-024-01245-7.

Utilization of Prognostic Biomarker Soluble Urokinase Plasminogen Activator Receptor in the Emergency Department: A Tool for Safe and More Efficient Decision-making.

Holstein R, Makinen M, Castren M, Kaartinen J Biomark Insights. 2022; 17:11772719221081789.

PMID: 35295966 PMC: 8918965. DOI: 10.1177/11772719221081789.

References

Haupt T, Petersen J, Ellekilde G, Klausen H, Thorball C, Eugen-Olsen J . Plasma suPAR levels are associated with mortality, admission time, and Charlson Comorbidity Index in the acutely admitted medical patient: a prospective observational study. Crit Care. 2012; 16(4):R130. PMC: 3580714. DOI: 10.1186/cc11434. View

Samaras N, Chevalley T, Samaras D, Gold G . Older patients in the emergency department: a review. Ann Emerg Med. 2010; 56(3):261-9. DOI: 10.1016/j.annemergmed.2010.04.015. View

Di Mauro F, Schoeffler G . Point of Care Measurement of Lactate. Top Companion Anim Med. 2016; 31(1):35-43. DOI: 10.1053/j.tcam.2016.05.004. View

Nemec M, Koller M, Nickel C, Maile S, Winterhalder C, Karrer C . Patients presenting to the emergency department with non-specific complaints: the Basel Non-specific Complaints (BANC) study. Acad Emerg Med. 2010; 17(3):284-92. DOI: 10.1111/j.1553-2712.2009.00658.x. View

Borne Y, Persson M, Melander O, Smith J, Engstrom G . Increased plasma level of soluble urokinase plasminogen activator receptor is associated with incidence of heart failure but not atrial fibrillation. Eur J Heart Fail. 2014; 16(4):377-83. DOI: 10.1002/ejhf.49. View

Chenevier-Gobeaux C, Lemarechal H, Doumenc B, Peschanski N, Claessens Y, Borderie D . Prognostic value of soluble urokinase plasminogen activator receptor in patients presenting to the emergency department with chest pain suggestive of acute coronary syndrome. Clin Biochem. 2021; 92:19-24. DOI: 10.1016/j.clinbiochem.2021.02.009. View

Gustafsson A, Ljunggren L, Bodelsson M, Berkestedt I . The Prognostic Value of suPAR Compared to Other Inflammatory Markers in Patients with Severe Sepsis. Biomark Insights. 2012; 7:39-44. PMC: 3329189. DOI: 10.4137/BMI.S9460. View

Ivic R, Kurland L, Vicente V, Castren M, Bohm K . Serious conditions among patients with non-specific chief complaints in the pre-hospital setting: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2020; 28(1):74. PMC: 7391698. DOI: 10.1186/s13049-020-00767-0. View

Djarv T, Castren M, Martenson L, Kurland L . Decreased general condition in the emergency department: high in-hospital mortality and a broad range of discharge diagnoses. Eur J Emerg Med. 2014; 22(4):241-6. DOI: 10.1097/MEJ.0000000000000164. View

10.

Vanpee D, Swine C, Vandenbossche P, Gillet J . Epidemiological profile of geriatric patients admitted to the emergency department of a university hospital localized in a rural area. Eur J Emerg Med. 2002; 8(4):301-4. DOI: 10.1097/00063110-200112000-00010. View

11.

Lafon T, Cazalis M, Vallejo C, Tazarourte K, Blein S, Pachot A . Prognostic performance of endothelial biomarkers to early predict clinical deterioration of patients with suspected bacterial infection and sepsis admitted to the emergency department. Ann Intensive Care. 2020; 10(1):113. PMC: 7423829. DOI: 10.1186/s13613-020-00729-w. View

12.

Schultz M, Rasmussen L, Kallemose T, Kjoller E, Lind M, Ravn L . Availability of suPAR in emergency departments may improve risk stratification: a secondary analysis of the TRIAGE III trial. Scand J Trauma Resusc Emerg Med. 2019; 27(1):43. PMC: 6458624. DOI: 10.1186/s13049-019-0621-7. View

13.

Martin-Loeches I, Wunderink R, Nanchal R, Lefrant J, Kapadia F, Sakr Y . Determinants of time to death in hospital in critically ill patients around the world. Intensive Care Med. 2016; 42(9):1454-60. DOI: 10.1007/s00134-016-4479-0. View

14.

Casagranda I, Vendramin C, Callegari T, Vidali M, Calabresi A, Ferrandu G . Usefulness of suPAR in the risk stratification of patients with sepsis admitted to the emergency department. Intern Emerg Med. 2015; 10(6):725-30. DOI: 10.1007/s11739-015-1268-7. View

15.

Bakker J, Coffernils M, Leon M, Gris P, Vincent J . Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest. 1991; 99(4):956-62. DOI: 10.1378/chest.99.4.956. View

16.

Eugen-Olsen J, Andersen O, Linneberg A, Ladelund S, Hansen T, Langkilde A . Circulating soluble urokinase plasminogen activator receptor predicts cancer, cardiovascular disease, diabetes and mortality in the general population. J Intern Med. 2010; 268(3):296-308. DOI: 10.1111/j.1365-2796.2010.02252.x. View

17.

Safwenberg U, Terent A, Lind L . The Emergency Department presenting complaint as predictor of in-hospital fatality. Eur J Emerg Med. 2007; 14(6):324-31. DOI: 10.1097/MEJ.0b013e32827b14dd. View

18.

Backes Y, van der Sluijs K, Mackie D, Tacke F, Koch A, Tenhunen J . Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review. Intensive Care Med. 2012; 38(9):1418-28. PMC: 3423568. DOI: 10.1007/s00134-012-2613-1. View

19.

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

20.

Castren M, Kurland L, Liljegard S, Djarv T . Non-specific complaints in the ambulance; predisposing structural factors. BMC Emerg Med. 2015; 15:8. PMC: 4437442. DOI: 10.1186/s12873-015-0034-5. View