SuPAR correlates with mortality and clinical severity in patients with necrotizing soft-tissue infections: results from a prospective, observational cohort study

Abstract

Necrotizing soft tissue infections (NSTI) have a 90-day mortality rate of 18–22%. Tools are needed for estimating the prognosis and severity of NSTI upon admission. We evaluated soluble urokinase-type plasminogen activator receptor (suPAR) levels at admission as a prognostic marker of NSTI severity and mortality. In a prospective, observational cohort study, suPAR was measured in 200 NSTI patients. We compared admission suPAR levels in survivors and non-survivors, patients with septic shock and non-shock, amputation and non-amputation, correlations with Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score. Admission suPAR levels were higher in septic shock vs. non-septic shock patients (9.2 vs. 5.8 ng/mL, p-value < 0.001) and non-survivors vs. survivors (11 vs. 6.1 ng/mL, p-value < 0.001) and correlated with SAPS II (r = 0.52, p < 0.001) and SOFA score (r = 0.64, p < 0.001). Elevated suPAR upon admission was associated with 90-day mortality (log-rank test p < 0.001), however not after adjustment for age, sex, and SOFA score. The AUC for suPAR and 90-day mortality was 0.77. We found that suPAR is a promising candidate for prognosis and severity in patients with NSTI.

Complement Activation Is Associated With Mortality in Patients With Necrotizing Soft-Tissue Infections—A Prospective Observational Study

“…In the survival analysis, ficolin-2 was the most promising of the above-mentioned PRMs, but the association with mortality disappeared after adjusting for SAPS II (13). Biomarkers outside of the complement system such as Procalcitonin and soluble urokinase plasminogen activator receptor (suPAR) have also been examined and they were not associated with mortality in the adjusted analyses (19,24).…”

“…At that point, many interventions have already been made (26). The new SAPS 3, can be calculated quicker since it uses data available within 1 h of ICU admission (27), but, as Polzik et al points out; it requires more variables to calculate, many of which may be missing upon admission (24). We wanted to compare the ROC curves for our complement parameters to the ROC curves for SAPS II, SOFA score on day 1, and the quickly available pH, base excess and lactate levels.…”

Discriminatory plasma biomarkers predict specific clinical phenotypes of necrotizing soft-tissue infections

“…The development of rapid diagnostic tools for NSTI, such as levels of disease-associated biomarkers, to support clinical decisions could increase the accuracy of early diagnosis, leading to swifter surgical exploration and treatment only when clinically indicated. However, to date, there are only a few studies of molecular biomarkers in NSTIs (22,(28)(29)(30)(31)(32), and these are limited to analyses of only a few markers. The comprehensive multiplex analysis of 36 analytes conducted here revealed, as expected, a greater systemic inflammatory response in NSTI patients than in noninfected patients (surgical controls).…”

Mortality and major complications after emergency laparotomy: A pilot study of risk prediction model development by preoperative blood‐based immune parameters

“…In line with our results, several studies have reported significant predictive abilities of suPAR in various acute and critically ill patients. 23,[28][29][30][31] High levels of suPAR may reflect an underlying state TA B L E 2 Blood-based immune parameter levels stratified for impaired physical performance and presence of sepsis TA B L E 3 Blood-based immune parameter levels stratified for disease etiology of low-grade inflammation and frailty not directly related to the acute condition. 32 The association between frailty and suPAR levels is supported by studies showing associations with subclinical organ damage and all-cause mortality in major cohorts.…”