suPAR in the assessment of post intensive care unit prognosis: a pilot study

ABSTRACT Objective: To determine the performance of soluble urokinase-type plasminogen activator receptor upon intensive care unit discharge to predict post intensive care unit mortality. Methods: A prospective observational cohort study was conducted during a 24-month period in an 8-bed polyvalent intensive care unit. APACHE II, SOFA, C-reactive protein, white cell count and soluble urokinase-type plasminogen activator receptor on the day of intensive care unit discharge were collected from patients who survived intensive care unit admission. Results: Two hundred and two patients were included in this study, 29 patients (18.6%) of whom died after intensive care unit discharge. Nonsurvivors were older and more seriously ill upon intensive care unit admission with higher severity scores, and nonsurvivors required extended use of vasopressors than did survivors. The area under the receiver operating characteristics curves of SOFA, APACHE II, C-reactive protein, white cell count, and soluble urokinase-type plasminogen activator receptor at intensive care unit discharge as prognostic markers of hospital death were 0.78 (95%CI 0.70 - 0.86); 0.70 (95%CI 0.61 - 0.79); 0.54 (95%CI 0.42 - 0.65); 0.48 (95%CI 0.36 - 0.58); and 0.68 (95%CI 0.58 - 0.78), respectively. SOFA was independently associated with a higher risk of in-hospital mortality (OR 1.673; 95%CI 1.252 - 2.234), 28-day mortality (OR 1.861; 95%CI 1.856 - 2.555) and 90-day mortality (OR 1.584; 95%CI 1.241 - 2.022). Conclusion: At intensive care unit discharge, soluble urokinase-type plasminogen activator receptor is a poor predictor of post intensive care unit prognosis.

摘要
## 研究目的
明确可溶性尿激酶型纤溶酶原激活物受体（soluble urokinase-type plasminogen activator receptor）在患者转出重症监护病房（intensive care unit，ICU）时，对其重症监护病房转出后死亡风险的预测效能。
## 研究方法
本研究为前瞻性观察队列研究，于一所设置8张床位的综合重症监护病房内开展，研究周期为24个月。纳入转出重症监护病房且存活的患者，收集其在转出当日的急性生理学与慢性健康状况评分系统II（APACHE II）、序贯器官衰竭评分（SOFA）、C反应蛋白水平、白细胞计数及可溶性尿激酶型纤溶酶原激活物受体水平。
## 研究结果
本研究共纳入202例患者，其中29例（18.6%）患者在转出重症监护病房后死亡。非存活患者年龄更大，且在重症监护病房入院时病情更为严重，病情严重程度评分更高，相较于存活患者，其需要更长时间使用血管活性药物。以重症监护病房转出当日的指标作为院内死亡的预后标志物，受试者工作特征曲线（receiver operating characteristics curve，ROC）下面积分别为：SOFA：0.78（95%置信区间95%CI 0.70~0.86）；APACHE II：0.70（95%CI 0.61~0.79）；C反应蛋白：0.54（95%CI 0.42~0.65）；白细胞计数：0.48（95%CI 0.36~0.58）；可溶性尿激酶型纤溶酶原激活物受体：0.68（95%CI 0.58~0.78）。SOFA评分与院内死亡（比值比（odds ratio，OR）1.673；95%CI 1.252~2.234）、28天死亡（OR 1.861；95%CI 1.856~2.555）及90天死亡（OR 1.584；95%CI 1.241~2.022）的更高风险独立相关。
## 研究结论
患者于重症监护病房转出当日，可溶性尿激酶型纤溶酶原激活物受体对其重症监护病房转出后预后的预测效能较差。