Biomarker Levels Prognostic for Septic Patients

An elevation in soluble urokinase-type plasminogen activator receptor (suPAR) levels may predict case fatality and is associated with severe sepsis.

The suPAR protein levels in the blood and other biomarkers, such as procalcitonin, have been evaluated as early prognostic markers of sepsis in patients with suspected infection

At the Satakunta Central Hospital (Pori, Finland) scientists conducted a prospective cohort study on 539 patients in the emergency department with suspected infection. The patients were divided into the following groups: in group1 comprised of 59 patients without systemic inflammatory response syndrome (SIRS) and without bacterial infection; group 2 were 68 patients with bacterial infection and without SIRS; group 3 were 54 patients with SIRS and without bacterial infection; group 4 were 309 patients with sepsis (SIRS and bacterial infection) and without organ failure and Group 5 were 49 patients with severe sepsis (SIRS, bacterial infection and organ failure.

Plasma suPAR levels were determined using a commercial double monoclonal antibody sandwich enzyme immunoassay (suPARnostic Standard Kit, ViroGates; Birkerød, Denmark). Procalcitonin (PCT) and interleukin-6 (IL-6) in plasma were measured with immunochemiluminometric assays in a Modular E170 automatic analyzer (Roche Diagnostics GmbH, Mannheim, Germany). C-reactive protein (CRP) in plasma was measured with an immunoturbidimetric assay using a Roche Diagnostics Modular P800 automatic analyzer.

The median suPAR concentrations were 4.7, 5.0, 4.4, 4.8, and 7.9 ng/mL in groups 1 through 5, respectively and levels were found to be significantly higher at 8.3 ng/mL in nonsurvivors compared with in survivors at 4.9 ng/mL. The suPAR level was found to have 76% sensitivity and 69% specificity for fatal disease, using a cut-off level of 6.4 ng/mL and 67% and 72% sensitivity and specificity, respectively, for severe sepsis at a cut-off level of 6.6 ng/mL. The scientists also evaluated PCT, interleukin 6, and C-reactive protein in this patient population and found that although suPAR was the best biomarker for case fatality, in further statistical analysis, PCT was a superior marker for severe sepsis.

The authors concluded, "It is tempting to think that measurement of suPAR may be used for triage to determine which patients with sepsis may require more comprehensive monitoring, as high suPAR levels in the emergency department may predict the need for more intensive therapeutic intervention." The study was published in the September 2012 issue of the Journal of Internal Medicine.

Related Links:
Satakunta Central Hospital
ViroGates
Roche Diagnostics