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

Overview

Journal Biomark Insights

Publisher Sage Publications

Date 2022 Mar 17

PMID 35295966

Authors

Ria M Holstein

Marja T Makinen

Maaret K Castren

Johanna M Kaartinen

Affiliations

Soon will be listed here.

Abstract

Introduction: Risk stratification in the emergency departments (EDs) is in critical need for new applications due to ED overcrowding and hospitalization of older people. We aimed to evaluate the expediency, efficiency and safety of a prognostic biomarker, soluble urokinase plasminogen activator receptor (suPAR), as a tool for the risk assessment of patients arriving at the ED.

Methods: We performed a comparative cross-sectional study in 2 emergency departments (EDs), suPAR measurements being incorporated into routine blood sampling in the intervention ED. The primary outcome was the number of discharges from the ED. The importance of the outcomes was examined by appropriate multi- or bivariate analysis.

Results: The absolute and relative number of discharges were similar between the intervention and control groups [121 (55.3%) vs 62 (55.9%)]. No significant differences between the groups were seen in the length of stays in the ED. Patients with low suPAR values were more likely discharged and patients with high suPAR values more likely admitted to hospital. Two admitted patients with low suPAR values could have been discharged safely.

Conclusion: The utilization of suPAR did not increase the risk for neither positive nor negative outcomes. Low suPAR values could be potential in discharging more patients safely. Instead of unselected patient populations, the benefits of suPAR measurements in the ED could emerge in the assessment of a more precisely determined and selected group of patients.

References

Velissaris D, Zareifopoulos N, Koniari I, Karamouzos V, Bousis D, Gerakaris A . Soluble Urokinase Plasminogen Activator Receptor as a Diagnostic and Prognostic Biomarker in Cardiac Disease. J Clin Med Res. 2021; 13(3):133-142. PMC: 8016523. DOI: 10.14740/jocmr4459. View

Donadello K, Scolletta S, Taccone F, Covajes C, Santonocito C, Orbegozo Cortes D . Soluble urokinase-type plasminogen activator receptor as a prognostic biomarker in critically ill patients. J Crit Care. 2013; 29(1):144-9. DOI: 10.1016/j.jcrc.2013.08.005. View

Rasmussen L, Ladelund S, Haupt T, Ellekilde G, Eugen-Olsen J, Andersen O . Combining National Early Warning Score With Soluble Urokinase Plasminogen Activator Receptor (suPAR) Improves Risk Prediction in Acute Medical Patients: A Registry-Based Cohort Study. Crit Care Med. 2018; 46(12):1961-1968. PMC: 6250248. DOI: 10.1097/CCM.0000000000003441. View

Seymour C, Cooke C, Wang Z, Kerr K, Yealy D, Angus D . Improving risk classification of critical illness with biomarkers: a simulation study. J Crit Care. 2013; 28(5):541-8. PMC: 3707977. DOI: 10.1016/j.jcrc.2012.12.001. View

Schultz M, Rasmussen L, Hoi-Hansen T, Kjoller E, Jensen B, Lind M . Early Discharge from the Emergency Department Based on Soluble Urokinase Plasminogen Activator Receptor (suPAR) Levels: A TRIAGE III Substudy. Dis Markers. 2019; 2019:3403549. PMC: 6545801. DOI: 10.1155/2019/3403549. View

Hayek S, Sever S, Ko Y, Trachtman H, Awad M, Wadhwani S . Soluble Urokinase Receptor and Chronic Kidney Disease. N Engl J Med. 2015; 373(20):1916-25. PMC: 4701036. DOI: 10.1056/NEJMoa1506362. View

Sando A, Schultz M, Eugen-Olsen J, Rasmussen L, Kober L, Kjoller E . Introduction of a prognostic biomarker to strengthen risk stratification of acutely admitted patients: rationale and design of the TRIAGE III cluster randomized interventional trial. Scand J Trauma Resusc Emerg Med. 2016; 24:100. PMC: 4974743. DOI: 10.1186/s13049-016-0290-8. View

Schultz M, Hartmann Rasmussen L, Andersen M, Stefansson J, Falkentoft A, Alstrup M . Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III). Scand J Trauma Resusc Emerg Med. 2018; 26(1):69. PMC: 6114851. DOI: 10.1186/s13049-018-0539-5. View

Alstrup M, Meyer J, Schultz M, Hartmann Rasmussen L, Rasmussen L, Kober L . Soluble Urokinase Plasminogen Activator Receptor (suPAR) as an Added Predictor to Existing Preoperative Risk Assessments. World J Surg. 2018; 43(3):780-790. DOI: 10.1007/s00268-018-4841-1. View

10.

Curovic V, Theilade S, Winther S, Tofte N, Eugen-Olsen J, Persson F . Soluble Urokinase Plasminogen Activator Receptor Predicts Cardiovascular Events, Kidney Function Decline, and Mortality in Patients With Type 1 Diabetes. Diabetes Care. 2019; 42(6):1112-1119. DOI: 10.2337/dc18-1427. View

11.

Rasmussen L, Schultz M, Iversen K, Eugen-Olsen J, Helms M, David K . Soluble urokinase plasminogen activator receptor (suPAR) is lower in disease-free patients but cannot rule out incident disease in patients with suspected cancer. Clin Biochem. 2020; 84:31-37. DOI: 10.1016/j.clinbiochem.2020.06.001. View

12.

Ivic R, Nurmi J, Kurland L, Vicente V, Lindstrom V, Djarv T . 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. Scand J Trauma Resusc Emerg Med. 2021; 29(1):116. PMC: 8358910. DOI: 10.1186/s13049-021-00908-z. View

13.

Velissaris D, Dimopoulos G, Parissis J, Alexiou Z, Antonakos N, Babalis D . Prognostic Role of Soluble Urokinase Plasminogen Activator Receptor at the Emergency Department: A Position Paper by the Hellenic Sepsis Study Group. Infect Dis Ther. 2020; 9(3):407-416. PMC: 7217599. DOI: 10.1007/s40121-020-00301-w. View

14.

LaMantia M, Stewart P, Platts-Mills T, Biese K, Forbach C, Zamora E . Predictive value of initial triage vital signs for critically ill older adults. West J Emerg Med. 2013; 14(5):453-60. PMC: 3789908. DOI: 10.5811/westjem.2013.5.13411. View

15.

Sun B, Hsia R, Weiss R, Zingmond D, Liang L, Han W . Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med. 2012; 61(6):605-611.e6. PMC: 3690784. DOI: 10.1016/j.annemergmed.2012.10.026. View

16.

Nayak R, Allingstrup M, Phanareth K, Kofoed-Enevoldsen A . suPAR as a biomarker for risk of readmission and mortality in the acute medical setting. Dan Med J. 2015; 62(10):A5146. View

17.

Hoot N, Aronsky D . Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008; 52(2):126-36. PMC: 7340358. DOI: 10.1016/j.annemergmed.2008.03.014. View

18.

Schuetz P, Hausfater P, Amin D, Amin A, Haubitz S, Faessler L . Biomarkers from distinct biological pathways improve early risk stratification in medical emergency patients: the multinational, prospective, observational TRIAGE study. Crit Care. 2015; 19:377. PMC: 4625457. DOI: 10.1186/s13054-015-1098-z. View

19.

Meyer J, Alstrup M, Rasmussen L, Schultz M, Ladelund S, Haupt T . suPAR is associated with risk of future acute surgery and post-operative mortality in acutely admitted medical patients. Scand J Trauma Resusc Emerg Med. 2018; 26(1):11. PMC: 5796401. DOI: 10.1186/s13049-018-0478-1. View

20.

Hayek S, Divers J, Raad M, Xu J, Bowden D, Tracy M . Predicting Mortality in African Americans With Type 2 Diabetes Mellitus: Soluble Urokinase Plasminogen Activator Receptor, Coronary Artery Calcium, and High-Sensitivity C-Reactive Protein. J Am Heart Assoc. 2018; 7(9). PMC: 6015289. DOI: 10.1161/JAHA.117.008194. View