Diagnostic accuracy of soluble urokinase plasminogen activator receptor (suPAR) for prediction of bacteremia in patients with systemic inflammatory response syndrome

Hoenigl, Martin; Raggam, Reinhard B.; Wagner, Jasmin; Valentin, Thomas; Leitner, Eva; Seeber, Katharina; Zollner‐Schwetz, Ines; Krammer, Werner; Prüller, Florian; Grisold, Andrea; Krause, Robert

doi:10.1016/j.clinbiochem.2012.11.004

Cited by 72 publications

(60 citation statements)

References 23 publications

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“…Recently, Donatello confirmed the predictive capacity of suPAR for bacteremia in a group of patients admitted for surgical sepsis or a medical cause in an ICU and Wittenhagen reported that serum levels of suPAR were greatly increased in pneumococcal bacteremia (5.5 ng/mL IQR 2.4-4.0 ng/mL vs 2.6 ng/mL IQR 1.5-4 ng/mL) (30,42). Differences of suPAR values in Gram-positive germs versus Gram-negative germs bacteremia were not recorded, result that is different from the conclusion of a larger study done on 132 patients with SIRS in which the values were significantly higher in Gram-negative bacteremia but the result is concordant with the results reported by Huttunen (21,40). Optimal cut-off value for suPAR in predicting sepsis bacteremia in our study was 9.885 ng/mL at which the specificity is modest but the sensitivity is excellent, owed to the small group of patients.…”

Section: Discussioncontrasting

confidence: 54%

“…(30, 40, 41). In our group, Gram-positive germs were predominant (9/14 strains, 64.2%), other authors also reporting Gram-negative germs as prevalent, constituting the majority (8,40).…”

Section: Discussionmentioning

confidence: 56%

“…Loonen reported on a group with similar admission criteria, statistically significant differences in the two BMs, reporting an AUC of 0.793 (95% CI 0.660-0.926) for suPAR in predicting bacteremia, comparable to the one identified in this study but inferior to the one for PCT evaluated at 0.806 (95% CI 0.669-0.913) (8). In another study in which the presence of SIRS and not infection was the inclusion criteria, AUC values for suPAR and PCT were very close and superior for the latter: 0.726 (95% CI 0.638-0.814) and respectively, 0.744 (95% CI 0.650-0.838), these two BMs continuing to be predictive bacteremia factors in SIRS patients, including after multivariable logistic regression analysis (40). Recently, Donatello confirmed the predictive capacity of suPAR for bacteremia in a group of patients admitted for surgical sepsis or a medical cause in an ICU and Wittenhagen reported that serum levels of suPAR were greatly increased in pneumococcal bacteremia (5.5 ng/mL IQR 2.4-4.0 ng/mL vs 2.6 ng/mL IQR 1.5-4 ng/mL) (30,42).…”

Section: Discussionmentioning

confidence: 99%

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Soluble urokinase-type plasminogen activator receptor (suPAR) – a possible biomarker for bacteremia in sepsis / Forma solubilă a receptorului pentru activatorul de plasminogen de tip urokinază (suPAR) – un biomarker posibil pentru bacteriemie în sepsis

Georgescu¹,

Szederjesi²,

Voidăzan³

et al. 2015

Romanian Review of Laboratory Medicine

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Background. Validating new sepsis biomarkers can contribute to early diagnosis and initiation of therapy. The aim of this study is to evaluate the sepsis predictive capacity of soluble urokinase plasminogen receptor (suPAR) and its role in evaluating the prognosis of bloodstream infections. Material and method. We conducted a prospective pilot study on 49 systemic inflammatory response syndrome (SIRS) patients admitted to the intensive care unit (ICU), that were divided, on the basis of bacteremia in group A (SIRS with bacteremia, n=14) and group B (SIRS without bacteremia, n=35). Hemoculture and blood samples were drawn on the first day to determine suPAR, C-reactive protein (CRP) and procalcitonin (PCT). We set to identify significant cut-off values in estimating bacteremia and mortality in septic patients. Results. In group A, suPAR values were 14.3 ng/mL (range 10-45.5 ng/mL) and in group B, 9.85 ng/mL (range 3.4-48 ng/mL) p=0.008. Area under the curve (AUC) for suPAR was 0.745 (95% CI: 0.600-0.859), for CRP 0.613 (95% CI: 0.522-0.799) and for PCT 0.718 (95% CI: 0.477-0.769). Cut-off value for suPAR in bacteremia prediction was 9.885 ng/mL, with 100% sensibility and 51.43% specificity. Mortality in group A was 85.7% (12/14) and in group B 74.3% (26/39), p>0.05. Area under the curve (AUC) for suPAR was 0.750 (95% CI: 0.455-0.936), for CRP 0.613 (95% CI: 0.413-0.913) and for PCT 0.618 (95% CI: 0.373-0.888). Cut-off value of suPAR in predicting mortality was 11.5 ng/mL, with 66.67% sensibility and 100% specificity. Conclusions. In our study suPAR had a predictive capacity for bacteremia and seems to be an independent factor for mortality prognosis in septic patients.

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Section: Discussioncontrasting

confidence: 54%

“…(30, 40, 41). In our group, Gram-positive germs were predominant (9/14 strains, 64.2%), other authors also reporting Gram-negative germs as prevalent, constituting the majority (8,40).…”

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

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Soluble urokinase-type plasminogen activator receptor (suPAR) – a possible biomarker for bacteremia in sepsis / Forma solubilă a receptorului pentru activatorul de plasminogen de tip urokinază (suPAR) – un biomarker posibil pentru bacteriemie în sepsis

Georgescu¹,

Szederjesi²,

Voidăzan³

et al. 2015

Romanian Review of Laboratory Medicine

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“…Procalcitonin (PCT) has been proposed as a useful diagnostic marker in the emergency department, although PCT may fail to rule out BSI (3,9,10).…”

mentioning

confidence: 99%

“…Early and reliable diagnosis for appropriate treatment is essential for improving the prognosis of infected patients. While so far, no single biomarker was able to replace time-consuming blood cultures, some, like procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6), are commonly used for additional assessments (2,3).…”

mentioning

confidence: 99%

Clinical Evaluation of Multiple Inflammation Biomarkers for Diagnosis and Prognosis for Patients with Systemic Inflammatory Response Syndrome

et al. 2014

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A multiplexed biomarker bundle consisting of nine different inflammation markers was evaluated regarding their diagnostic and prognostic performances in 159 adult systemic inflammatory response syndrome (SIRS) patients enrolled at the emergency department. Fibronectin, interleukin-8 (IL-8), biotin, and neutrophil gelatinase-associated lipocalin (NGAL) were the most robust markers but were not superior to the already established markers IL-6, C-reactive protein (CRP), procalcitonin (PCT), and soluble urokinase plasminogen activator receptor (suPAR). Bloodstream infection (BSI) in patients with systemic inflammatory response syndrome (SIRS) is associated with substantial morbidity and mortality (1). Early and reliable diagnosis for appropriate treatment is essential for improving the prognosis of infected patients. While so far, no single biomarker was able to replace time-consuming blood cultures, some, like procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6), are commonly used for additional assessments (2, 3).Recently, a new CE-marked in vitro diagnostic (IVD)-approved multiplex analysis system (Anagnostics Bioanalysis GmbH, Vienna, Austria) for testing inflammatory biomarkers was introduced to the market, using competitive and sandwich immunoassays. This test system is a fully automated instrument that may provide extended and rapid inflammation monitoring in a single run; the time to result is 3 min per sample, and 8 samples can be measured consecutively in one run.The objective of this study was to evaluate the diagnostic (for positive blood cultures caused by Staphylococcus aureus, Escherichia coli, or Candida spp.) and prognostic performances of the biomarker bundle in patients fulfilling the SIRS criteria (all patients had fever and fulfilled one or more additional SIRS criteria) at the emergency department (ED).(This paper was presented in part at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy [ICAAC], 5 to 9 September 2014, Washington, DC [14].)The biomarkers were evaluated in 159 adult patients who were included consecutively at the Medical University of Graz, Austria, between June 2012 and March 2013. All the biomarker levels (routinely tested and multiplexed) and blood culture results originated from blood samples taken when patients presented to the emergency department, before anti-infective treatment was initiated. The additional inclusion criteria were (i) no anti-infective treatment during the 5 days before blood samples were obtained, (ii) informed consent (approved by the ethics committee, Medical University Graz, Austria, no. 21-469 ex 09/10), (iii) positive blood culture results with growth of S. aureus, E. coli, or Candida spp., or negative blood culture results, and (iv) the anticipated limit of about 50 patients in each study group had not been reached. Inclusion criteria (iii) and (iv) were applied only for retrospective testing of the biomarker bundle (see details below).

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Plasma interleukin-6 concentration for the diagnosis of sepsis in critically ill adults

Molano-Franco

Arévalo-Rodríguez

Figuls

et al. 2019

Cochrane Database of Systematic Reviews

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Diagnostic accuracy of soluble urokinase plasminogen activator receptor (suPAR) for prediction of bacteremia in patients with systemic inflammatory response syndrome

Cited by 72 publications

References 23 publications

Soluble urokinase-type plasminogen activator receptor (suPAR) – a possible biomarker for bacteremia in sepsis / Forma solubilă a receptorului pentru activatorul de plasminogen de tip urokinază (suPAR) – un biomarker posibil pentru bacteriemie în sepsis

Soluble urokinase-type plasminogen activator receptor (suPAR) – a possible biomarker for bacteremia in sepsis / Forma solubilă a receptorului pentru activatorul de plasminogen de tip urokinază (suPAR) – un biomarker posibil pentru bacteriemie în sepsis

Clinical Evaluation of Multiple Inflammation Biomarkers for Diagnosis and Prognosis for Patients with Systemic Inflammatory Response Syndrome

Plasma interleukin-6 concentration for the diagnosis of sepsis in critically ill adults

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