Plasma suPAR as a prognostic biological marker for ICU mortality in ARDS patients
We investigated the prognostic value of plasma soluble urokinase plasminogen activator receptor (suPAR) on day 1 in patients with the acute respiratory distress syndrome (ARDS) for intensive care unit (ICU) mortality and compared it with established disease severity scores on day 1.
suPAR was determined batchwise in plasma obtained within 24 h after admission.
632 ARDS patients were included. Significantly (P = 0.02) higher median levels of suPAR were found with increasing severity of ARDS: 5.9 ng/ml [IQR 3.1–12.8] in mild ARDS (n = 82), 8.4 ng/ml [IQR 4.1–15.0] in moderate ARDS (n = 333), and 9.0 ng/ml [IQR 4.5–16.0] in severe ARDS (n = 217). Non-survivors had higher median levels of suPAR [12.5 ng/ml (IQR 5.1–19.5) vs. 7.4 ng/ml (3.9–13.6), P < 0.001]. The area under the receiver operator characteristic curve (ROC-AUC) for mortality of suPAR (0.62) was lower than the ROC-AUC of the APACHE IV score (0.72, P = 0.007), higher than that of the ARDS definition classification (0.53, P = 0.005), and did not differ from that of the SOFA score (0.68, P = 0.07) and the oxygenation index (OI) (0.58, P = 0.29). Plasma suPAR did not improve the discrimination of the established disease severity scores, but did improve net reclassification of the APACHE score (29 %), SOFA score (23 %), OI (38 %), and Berlin definition classification (39 %).
As a single biological marker, the prognostic value for death of plasma suPAR in ARDS patients is low. Plasma suPAR, however, improves the net reclassification, suggesting a potential role for suPAR in ICU mortality prediction models.
KeywordsARDS ICU mortality suPAR Biological marker
ViroGates A/S, Denmark, donated the ELISA kits for measuring suPAR free of charge. The company had no influence on study design, results, and the decision to publish results. Supported by the Center for Translational Molecular Medicine (http://www.ctmm.nl), project MARS (grant 04I-201).
Conflicts of interest
MJS serves as an advisor of Virogates A/S, Denmark. He has no financial interests in the company. The authors declare that they have no competing interests.
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