The significance of serum urokinase plasminogen activation receptor (suPAR) in the diagnosis and follow-up of febrile neutropenic patients with hematologic malignancies (original) (raw)
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Pediatric Hematology and Oncology, 2016
Aim: The urokinase-type plasminogen activator (uPA) system consists of a protease, a receptor (urokinase-type plasminogen activator receptor, uPAR), and inhibitors that can be expressed on various cell types. Previous literature shows that the amount of soluble urokinase-type plasminogen activator receptor (suPAR) secreted from affected cells is higher in Crimean-Congo hemorrhagic fever (CCHF) patients than in healthy controls. Thus, we aimed to investigate the diagnostic value of suPAR in the differential diagnosis of CCHF in emergency services. Material and Methods: Individuals over 16 years old with a preliminary diagnosis of CCHF disease were divided into two groups as real time-polymerase chain reaction (RT-PCR) and/or IgM positive (CCHF group) and RT-PCR and/or IgM negative (control group). Results: Eighty patients were included in this study. Forty patients with CCHF virus PCR and/or CCHF virus IgM were identified as CCHF group and 40 patients included as negative control group. The median age of the patients was 45 (range, 16-91) years, and 49 patients (61.3%) were male. Leukocyte, platelet, and fibrinogen levels were significantly lower, while creatinine kinase, aPTT, and D-dimer levels were significantly higher in CCHF group. There was no statistically significant difference between the control group and CCHF group for SuPAR (p=0.386). In addition, control group patients not diagnosed with CCHF were examined, brucellosis, influenza, and pneumonia were found to be the most common. Conclusion: The use of suPAR as a biomarker in the differentiation of patients with similar findings in emergency services was investigated and found to have no diagnostic value.
Soluble urokinase plasminogen activator receptor (suPAR) in the emergency department: An update
Caspian journal of internal Medicine, 2022
Background: The biomarker soluble urokinase plasminogen activator receptor (suPAR) is an indicator of inflammation which is increased in a variety of chronic and acute disease states. Its most promising application in the emergency setting is to aid in the prognostic stratification of patients by identifying those at high risk of deterioration. This is a narrative review of studies evaluating the use of suPAR Methods: We conducted a Medline search for studies on the use of suPAR in patients acutely admitted to the emergency department. Results: 25 original studies were included in the review. suPAR as a marker of inflammation has been used alone or combined to other inflammatory biomarkers in the assessment of patients suffering from various acute and chronic diseases in an emergency setting. As it is non-specific, it may increase in infectious disease, malignancy or acute coronary syndromes among other conditions, but quantitative suPAR levels correlate with disease severity. It may be useful for the identification of high risk patients regardless of underlying pathology. Conclusion: As the ideal biomarker in the emergency setting has not been identified yet, suPAR may be a promising addition to the established biomarkers for the initial assessment of patients in this setting. Additional research is necessary to evaluate the usefulness of suPAR guided management algorithms.
Acta Clinica Belgica, 2019
Aim: The purpose of this review is to summarize all relevant publications regarding the use and validity of the soluble urokinase plasminogen activator receptor (suPAR) when used by clinicians in the emergency department (ED) for the detection and monitoring of patients with sepsis syndrome. Methods: A PubMed search was conducted in order to identify all publications related to the use of suPAR in sepsis patients in the ED setting. Results: Although suPAR is actively involved in the pathophysiology of sepsis, over the last 15 years, only a few studies have been published referring to its predictive validity in the ED. Conclusions: SuPAR can be easily and rapidly measured in an ED setting, and its role in the exclusion of an infection and the management of sepsis, alone or in combination to other biomarkers, should be further evaluated. The optimal cutoff value, the timing of the measurement and the role of the suPAR in an ED setting should be further investigated.
In light of the accumulating evidence on the negative predictive value of soluble urokinase plasminogen activator receptor (suPAR), a group of experts from the fields of intensive care medicine, emergency medicine, internal medicine and infectious diseases frame a position statement on the role of suPAR in the screening of patients admitted to the emergency department. The statement is framed taking into consideration existing publications and our own research experience. The main content of this statement is that sUPAR is a non-specific marker associated with a high negative predictive value for unfavourable outcomes; levels \ 4 ng/ml indicate that it is safe to discharge the patient, whereas levels [ 6 ng/ml are an alarming sign of risk for unfavourable outcomes.
Evaluation of Diagnostic Value of Soluble Urokinase-Type Plasminogen Activator Receptor in Sepsis
Archives of Clinical Infectious Diseases, 2014
Background: Sepsis is one of the most important causes of morbidity and mortality in the intensive care units (ICUs). It is difficult to accurately differentiate sepsis from similar diseases rapidly. Therefore, it becomes critical to identify any biomarker with the ability of differentiation between sepsis and nonsepsis conditions. The urokinase plasminogen activator receptor has been implicated as an important factor in regulation of leukocyte adhesion and migration. Objectives: In this study, we evaluated the value of soluble urokinase plasminogen activator receptor (suPAR), erythrocyte sedimentation (ESR), and C-reactive protein (CRP) serum levels in terms of their value for sepsis diagnosis in ICU patients. Patients and Methods: We enrolled 107 ICU patients; 40 with sepsis, 43 with systemic inflammatory response syndrome, and 24 as control group. Serum soluble urokinase plasminogen activator receptor, ESR, white blood cell (WBC), and CRP levels were measured on the day of admission. Results: The group with sepsis had higher suPAR, ESR, and CRP levels compared with the group with noninfectious systemic inflammatory response syndrome (SIRS) (P = 0.01, 0.00 and 0.00, respectively). CRP concentrations and ESR were higher in the sepsis group than in the non-SIRS group (P = 0.00 and 0.00, respectively). In a receiver-operating characteristic curve analysis, ESR, CRP and suPAR had an area under the curve larger than 0.65 (P = 0.00) in distinguishing between septic and noninfectious SIRS patients. CRP, ESR and suPAR had a sensitivity of 87%, 71% and 66% and a specificity of 59%, 76% and 74% respectively in diagnosing infection in SIRS.
Objective: validation of Soluble urokinase plasminogen activator receptor (suPAR) as a prognosis bio-marker in patients attended for sepsis in an Emergency Department. Methods: patients diagnosed of severe inflamatory response syndrome (SIRS), sepsis and septic shock at the La Paz University Hospital (HULP) emergency department (ED) were eligible for the study. The study was approved by the hospital etical committee [CEIC] and all patients signed a written consent. Clinical, analitical, and microbiological data, as well as a serum sample to measure the suPAR level, were collected in the first 6 hours since diagnosis. Windows 15 SPSS program was used for statistical analysis. Chi-square test (or Fisher exact test) and Student-T or ANOVA (or Mann-Whitney U-test, or Kruskal-Wallis test) were applied to evaluate the prognosis usefulness of suPAR, C-reactive protein (CRP), procalcitonine (PCT) and lactate. A Receiver Operating Characteristic (ROC) Curve of Sensibility against [1-Specificity] was created in order to decide whether suPAR plasmatic level could determine the global survival rate in these patients. Results: 36 patients were enrollled (6,1% with SIRS, 69,7% with sepsis, and 24,2% with septic shock) with a median age of 69,1+15,0 years old. 12 patients (33,3%) were admitted at the Intensive Care Unit (ICU). 10 patients (27,8%) died during the first 30 days. Plasma suPAR levels (ng/mL) in the group of patients who died were 8,6 + 3,8 versus 6,1 + 2,5 in the surviving group. CRP levels (mg/L) were 185,5 + 109,1 versus 121,22 + 137,7. PCT levels (ng/mL) were 16,7 + 7,2 versus 12,8 + 4,1. Lactate levels (mmol/L) were 4,6 + 3,9 versus 2,5 + 1,3. Only plasmatic suPAR levels showed statistical relationship with mortality during the first 30 days. The ROC curve for suPAR plasmatic values showed an Area Under the Curve (AUC) of 0,717 (95% CI 0,517-0,917, p=0.046). The best sensibility-specificity balanced cutoff point for predicting mortality was 6,9 ng/mL (70% sensibility and 65,4% specificity). Conclusions: a single suPAR plasmatic level measure is an independent biomarker with an acceptable predictive value in septic patients with different stages of disease severity. Its routinary use in the daily clinical practice could improve sepsis management and avoid progression to more severe stages of the disease. Abstract Resumen Objetivo: validación de suPAR como biomarcador pronostico en pacientes sépticos en un Servicio de Urgencias Hospitalario. Materiales y métodos: pacientes: se incluyeron pacientes con SIRS, sepsis y shock séptico diagnosti-cados en el SU del Hospital Universitario La Paz (HULP). Se recogieron variables clínicas, analíticas y microbiológicas, así como una muestra para la determinación de suPAR en las 6 primeras horas desde el diagnostico. Este estudio ha sido aprobado por el CEIC del HULP y todos los pacientes firmaron su consentimiento informado. Análisis estadístico: Se empleó el programa SPSS versión 15 para Windows. Se utilizó el test Chi-cuadrado (o el test exacto de Fisher) y la T de Student o el ANOVA (o la U de Mann-Whitney o el test de Kruskal-Wallis) para evaluar la utilidad pronóstica del suPAR, PCR, PCT y lactato. Se generó una curva ROC (Receiver Operating Characteristic) de sensibilidad versus 1-especificidad para determinar si el nivel plasmático de suPAR podía discriminar supervivencia global en pacientes sépticos en el SUH.