Table 2 |
||||||
|
Studies evaluating the prognostic value of soluble urokinase-type plasminogen activator receptor (suPAR) levels |
||||||
|
First author |
Type |
Pathology |
Patients |
Period |
Main results |
Comments |
|
|
||||||
|
Sidenius, 2000 [33] |
Retrospective |
HIV |
314 adults, samples taken at enrollment |
1991 to 1992 |
Range of suPAR levels 1.15 to 15.60 ng/ml. Low (< 3.28 ng/ml), medium (3.28-4.19 ng/ml) and high (> 4.19 ng/ml) suPAR levels related to increasing risk of AIDS-related death. Hazard ratio for death was 2.2 for medium suPAR levels (vs low) and 4.7 for high suPAR levels |
Samples were not all obtained at enrollment |
|
Eugen-Olsen, 2002 [29] |
Retrospective |
Mycobacterium tuberculosis |
262 adults, samples taken at enrollment in a cohort based on suspicion of active tuberculosis 8 month-follow-up for 101 patients |
1996 to1998 |
Elevated levels in active TB. 1.25 increase in mortality per ng increase in suPAR. |
Not all patients were followed-up |
|
Ostrowski, 2005 [30] |
Prospective |
HIV |
59 healthy individuals + 99 HIV patients. Samples taken at study inclusion-median time from first positive HIV antibody test was 8 (5 to 9) years |
2000 to 2001 |
Higher levels predicted increased mortality risk. suPAR(I-III) and (II-III) are independent predictors of mortality |
Measurement of suPAR (I-III),(II-III) and (I) forms |
|
Ostrowski, 2005 [28] |
Prospective |
Malaria |
645 African children with clinical symptoms of malaria: 478 had malaria.14 healthy children as controls. Samples taken at hospital admission. |
June to August of 2000 and 2001 |
Highest concentrations in non-survivors (11) or with complicated malaria. 1 ng/mL increase in suPAR concentration was associated with increased mortality (OR 1.42) |
Low platelet count and hemoglobin level, high neutrophil count were independent predictors of high plasma concentration of suPAR |
|
Lawn, 2007 [32] |
Prospective |
HIV |
293 adults. Samples taken at enrollment for antiretroviral treatment |
Sept 2002 to Feb 2005 5 month follow-up after enrollment |
Significantly higher suPAR levels in non survivors. Log10 suPAR strongly associated with death |
No discriminatory cut-off point to provide clinically useful information |
|
Yilmaz, 2010 [22] |
Retrospective |
CCHF |
100 adults, samples taken at hospital admission |
2006 to 2009 38 months |
Cut-off value of 10.6 ng/ml AUC 0.97 |
Only 5/100 deaths No comparison with other infections |
|
Kofoed, 2008 [34] |
Retrospective sample analysis |
Suspected sepsis 64% bacterial infection |
151 adults, samples taken at ED admission |
12 months |
Mortality: suPAR AUROC 0.80 (sensitivity 89%, specificity 63%, 95% CI 0.69-0.92). suPAR and age AUROC 0.92 (sensitivity 100%, specificity 78%, 95% CI 0.86-0.97) |
PCT and CRP had no prognostic value |
|
Ostergaard, 2004 [24] |
Prospective |
CNS infection |
183 adults. Samples taken at admission |
1988 to 2002 |
Positive correlation of CSF suPAR levels with prognosis; cut-off 3.1 mcg/l had OR for death of 11.9 (95% CI 1.4-106) |
Multivariate analysis was not possible due to small number of deaths |
|
Wittenhagen, 2004 [14] |
Multicenter prospective study |
S. Pneumonia bacteremia |
141 adults. Samples taken at hospital admission |
1999 to 2001; 21 months |
Higher suPAR levels in patients compared to healthy volunteers (median 5.5, range 2.4 to 21.0 ng/ml). Levels > 10 ng/ml independent predictor of mortality (OR 13, specificity 95%, sensitivity 38%, NPV 88%, PPV 60%) |
Logistic multivariate regression analysis |
|
Huttunen, 2011 [8] |
Prospective cohort study |
Bacteremia |
132 adults. Samples taken at day 1 after the first positive blood culture |
June 1999 to Feb 2004 |
11 ng/ml AUROC 0.84 (95% CI 0.76 to 0.93, sensitivity 83%, specificity 76%). Higher levels associated with disease severity. OR for mortality16.1 (95%CI 4.3 to 59.9-logistic regression analysis) |
Plasma samples were not taken at admission |
|
Molkanen, 2011 [36] |
Retrospective sample analysis |
S. aureus bacteremia |
59 adults. Samples taken on day 3, after positive blood culture |
suPAR AUROC for mortality 0.754 (95% CI 0.615 to 0.894, P = 0.003) CRP AUROC 0.596. Cut-off 9.25 ng/ml |
Plasma samples not taken at admission |
|
|
Koch, 2011 [26] |
Prospective |
Critical illness medical ICU |
273 adults, 197 septic. Samples taken at ICU admission |
Undefined |
Correlation of suPAR levels with APACHE II score (r = 0.345, P < 0.001), SOFA score (r = 0.337, P = 0.004), SAPS II score (r = 0.271, P = 0.004) and the need for VP and MV. Unadjusted OR for mortality 1.07 (95% CI 1.02 to 1.11) Cut-off value for mortality 8 ng/ml (day 1) to 13 ng/ml (day 3) |
AUROC for ICU/overall survival larger (0.68/0.64) than CRP (0.52/0.53), PCT (0.55/0.55) and APACHE II (0.54/0.60), smaller than SAPS2 (0.81/0.74) |
|
Donadello, 2011 [27] |
Prospective |
Critical illness, medico-surgical ICU |
152 adults, 55 septic. Samples taken at ICU admission |
December 2010 to March 2011 |
Cut-off value 6 ng/ml (sensitivity 63%, specificity 60%). AUROC for mortality 0.71 (95% CI 0.60 to 0.81) in overall population, in septic patients 0.68 (95% CI 0.47 to 0.88) |
Preliminary data |
|
|
||||||
|
AIDS: acquired immunodeficiency syndrome; APACHE II, Acute Physiology And Chronic Health Evaluation II; AUROC, area under the receiver operating characteristic curve; CCHF, Crimean Congo Hemorrhagic Fever; CNS, central nervous system; CRP, C-reactive protein; CSF, cerebrospinal fluid; ED, emergency department; MV, mechanical ventilation; NPV, negative predictive value; PCT, Procalcitonin; PPV, positive predictive value; OR, odds ratio; SAPS, Simplified Acute Physiology Score; SOFA, sequential organ failure assessment; TB, tuberculosis; VP, vasopressors. |
||||||
|
Donadello et al. BMC Medicine 2012 10:2 doi:10.1186/1741-7015-10-2 |
||||||
