suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19.

IF 3.4 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Biomarker Insights Pub Date : 2021-08-15 eCollection Date: 2021-01-01 DOI:10.1177/11772719211034685

Izzet Altintas, Jesper Eugen-Olsen, Santeri Seppälä, Jens Tingleff, Marius Ahm Stauning, Nora Olsen El Caidi, Sanaá Elmajdoubi, Hejdi Gamst-Jensen, Mette B Lindstrøm, Line Jee Hartmann Rasmussen, Klaus Tjelle Kristiansen, Christian Rasmussen, Jan O Nehlin, Thomas Kallemose, Harri Hyppölä, Ove Andersen

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引用次数: 15

Abstract

Objectives: Elevated soluble urokinase Plasminogen Activator Receptor (suPAR) is a biomarker associated with adverse outcomes. We aimed to investigate the associations between plasma suPAR levels (testing the cut-offs ⩽4, 4-6, and ⩾6 ng/mL) with risk of 14-day mortality, and with the risk of mechanical ventilation in patients that tested positive for SARS-CoV-2.

Methods: Observational cohort study of patients presenting with symptoms of COVID-19 at Department of Emergency Medicine, Amager and Hvidovre Hospital, Denmark from March 19th, 2020 to April 3rd, 2020. Plasma suPAR was measured using suPARnostic technologies. Patients were followed for development of mechanical ventilation and mortality for 14 days. Validation of our findings were carried out in a similar sized COVID-19 patient cohort from Mikkeli Central Hospital, Finland.

Results: Among 386 patients with symptoms of COVID-19, the median (interquartile range) age was 64 years (46-77), 57% were women, median suPAR was 4.0 ng/mL (2.7-5.9). In total, 35 patients (9.1%) died during the 14 days follow-up. Patients with suPAR ⩽4 ng/mL (N = 196; 50.8%) had a low risk of mortality (N = 2; 1.0%; negative predictive value of 99.0%, specificity 55.3%, sensitivity 95.2%, positive predictive value 17.4%). Among patients with suPAR ⩾6 ng/mL (N = 92; 23.8%), 16 died (17.4%). About 99 patients (25.6%) tested positive for SARS CoV-2 and of those 12 (12.1%) developed need for mechanical ventilation. None of the SARS-CoV-2 positive patients with suPAR ⩽4 ng/mL (N = 28; 38.8%) needed mechanical ventilation or died. The Mikkeli Central Hospital validation cohort confirmed our findings concerning suPAR cut-offs for risk of development of mechanical ventilation and mortality.

Conclusions: Patients with symptoms of COVID-19 and suPAR ⩽4 or ⩾6 ng/mL had low or high risk, respectively, concerning the need for mechanical ventilation or mortality. We suggest cut-offs for identification of risk groups in patients presenting to the ED with symptoms of or confirmed COVID-19.

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COVID-19症状患者风险分层的suPAR截止值

目的:升高的可溶性尿激酶纤溶酶原激活物受体(suPAR)是与不良结局相关的生物标志物。我们的目的是研究血浆suPAR水平(测试截断值≤4、4-6和小于或等于6 ng/mL)与14天死亡率风险之间的关系，以及与SARS-CoV-2检测阳性患者的机械通气风险之间的关系。方法:对2020年3月19日至2020年4月3日在丹麦Amager和Hvidovre医院急诊科出现COVID-19症状的患者进行观察队列研究。血浆suPAR采用超监测技术测量。随访患者机械通气情况及死亡率14天。我们的研究结果在芬兰米凯利中心医院的一个类似规模的COVID-19患者队列中进行了验证。结果:386例新冠肺炎症状患者中，年龄中位数(四分位数间距)为64岁(46 ~ 77岁)，57%为女性，suPAR中位数为4.0 ng/mL(2.7 ~ 5.9)。在14天的随访期间，共有35名患者(9.1%)死亡。suPAR≥4 ng/mL患者(N = 196;50.8%)死亡风险低(N = 2;1.0%;阴性预测值99.0%，特异度55.3%，敏感性95.2%，阳性预测值17.4%)。suPAR小于6 ng/mL的患者中(N = 92;23.8%)，死亡16例(17.4%)。约99名患者(25.6%)检测出SARS - CoV-2阳性，其中12名患者(12.1%)需要机械通气。无suPAR≥4 ng/mL的SARS-CoV-2阳性患者(N = 28;38.8%)需要机械通气或死亡。Mikkeli中心医院验证队列证实了我们关于suPAR切断机械通气发展风险和死亡率的研究结果。结论:具有COVID-19症状和suPAR≥4或大于或小于6 ng/mL的患者在需要机械通气或死亡方面分别具有低或高风险。我们建议在出现COVID-19症状或确诊症状的急诊科患者中确定风险群体的临界值。

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