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
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, suPAR）在重症监护病房（intensive care unit, ICU）出院时对重症监护后死亡风险的预测效能。
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开展，研究周期为24个月。纳入重症监护病房住院期间存活的患者，收集其于重症监护病房出院当日的急性生理学与慢性健康状况评分II（Acute Physiology and Chronic Health Evaluation II, APACHE II）、序贯器官衰竭评分（Sequential Organ Failure Assessment, SOFA）、C反应蛋白、白细胞计数以及可溶性尿激酶型纤溶酶原激活物受体水平。
结果：本研究共纳入202例患者，其中29例（18.6%）在重症监护病房出院后发生死亡。非存活患者年龄更大，重症监护病房入院时病情更为危重，病情评分更高，且相较于存活患者，其血管活性药物使用时长更长。以重症监护病房出院时的各项指标作为院内死亡预后标志物，其受试者工作特征曲线（receiver operating characteristics curve, ROC）下面积分别为：SOFA评分0.78（95%CI 0.70~0.86）、APACHE II评分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（优势比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）的高风险独立相关。
结论：重症监护病房出院时，可溶性尿激酶型纤溶酶原激活物受体对重症监护后预后的预测效能不佳。