Elevated soluble urokinase receptor values in CSF, age and bacterial meningitis infection are independent and additive risk factors of fatal outcome

Abstract

The aim of the present study was to evaluate the potential role of cerebrospinal fluid soluble urokinase receptor (suPAR) level, infection and age as risk factors for fatal outcome in patients suspected of having meningitis and/or bacteraemia on admission to hospital. A total of 545 cerebrospinal fluid samples from patients with clinically suspected meningitis were sent to the Hellenic National Meningitis Reference Laboratory. Ten of 545 (1.83%) patients died. Analysis by receiver operating characteristics (ROC) curve revealed that both suPAR and age were significant for prediction of fatal outcome. Patients with levels of suPAR above the cut-off values and age ≥ 51 years, or patients in which either Neisseria meningitis or Streptococcus pneumoniae were detected were categorized as high risk patients. The combination of the above three predictors (suPAR, age and infectious agent) in a logistic regression model with outcome of infection as the dependent variable yielded an overall odds ratio (OR = 85.7, 95% CI 10.6-690.2) with both sensitivity and specificity being equal to the value of 0.9. In conclusion, suPAR, age and type of infection have an additive effect in predicting mortality among patients suspected of meningitis.

Soluble urokinase plasminogen activator receptor is compartmentally regulated in decompensated cirrhosis and indicates immune activation and short‐term mortality

“…The AF levels of suPAR were only elevated in the presence of active infection, implying that the peritoneal infiltrate is responsible for the local level. In agreement with our results, increased local levels of suPAR in cerebrospinal fluid during bacterial meningitis and in bronchoalveolar lavage specimens from patients with inhalation trauma are associated with the extent of local inflammation. Mesothelial cells have been shown to release suPAR in response to LPS and inflammation .…”

The significance of serum urokinase plasminogen activation receptor (suPAR) in the diagnosis and follow-up of febrile neutropenic patients with hematologic malignancies

“…suPAR is known to increase in several inflammatory and infectious diseases, and the rise in serum level has a negative effect on the clinical course. [8][9][10] The most striking study to date regarding suPAR in patients with hematologic malignancies is that by Haastrup et al involving 20 allogeneic stem cell recipients. 11 In that study, pre-transplant suPAR values were higher than those of the control group; suPAR values were monitored weekly for 1 month post-transplant.…”

Blood-brain barrier damage as a predictor of outcome in patients with purulent meningitis

“…Furthermore, even though the CSF cultures become sterile for 24-48 h with antibiotic treatment, the high rate of mortality and neurological complications demand additional research work [5,14,23,32]. Animal research showed that bacterial lysis results in increased subarachnoid inflammation, increasing the risk of a worse outcome of the disease [3,17], as a result of releasing inflammatory interleukins through destroying bacteria [4][5][6]30].…”