suPAR is associated with risk of future acute surgery and post-operative mortality in acutely admitted medical patients

Abstract

BackgroundAcutely admitted medical patients are often fragile and in risk of future surgery. The biomarker soluble urokinase plasminogen activator receptor (suPAR) is a predictor of readmission and mortality in the acute care setting. We aimed to investigate if suPAR also predicts acute surgery, which is associated with higher mortality than elective surgery, and if it predicts post-operative mortality.MethodsA retrospective registry-based cohort study of 17,312 patients admitted to an acute medical unit in Denmark, from 18 November 2013 until 30 September 2015. The first admission with available suPAR was defined as the index admission, and patients were followed via national registries until 1 January 2016. The risk of acute surgery during the entire follow-up period as well as the 90-day post-operative mortality risk was modeled by Cox regression analyses adjusted for sex, age, C-reactive protein, and Charlson Comorbidity Index (Charlson Score).ResultsAcute surgery was carried out on 2404 patients (13.9%) after a median of 45 days (interquartile range 5–186) following the index admission. Patients receiving acute surgery had higher baseline suPAR compared with patients receiving elective- or no surgery (p < 0.0001). The hazard ratio (HR) for acute surgery was 1.50 (95% confidence interval (CI): 1.42–1.59) for every doubling of the suPAR level in the adjusted Cox regression analysis. Death within 90 days occurred in 439 (18.3%) patients receiving acute surgery, and the adjusted HR for post-operative mortality was 1.73 (95% CI: 1.52–1.95).DiscussionElevated levels of suPAR in acutely admitted medical patients were independently associated with increased risk of future acute surgery as well as with 90-day post-operative mortality.Trial registrationThis retrospective registry-based cohort study was approved by the Danish Health and Medicines authority (reference no. 3–3013-1061/1). All processing of personal data followed national guidelines, and the project was approved by the Danish Data Protection Agency (reference no. HVH-2014-018, 02767).

Elevated preoperative suPAR is a strong and independent risk marker for postoperative complications in high-risk patients undergoing major non-cardiac surgery (SPARSE)

“…16 Our study shows a significantly increased prediction of postoperative complications and further strengthen the potential of suPAR as a preoperative risk marker. Based on our findings, and the findings of others, 16,45,46 suPAR may improve the accuracy of ASA score and could also be used as a central parameter in enhanced recovery after surgery protocols. Of note, the other preoperative risk assessment models used in our study have significant limitations.…”

suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department

“…It has previously shown that low suPAR is associated with low risk of adverse outcomes for acute medical patients, such as acute kidney injury [ 16 , 17 ], acute surgery [ 18 ], and overall mortality [ 12 ]. These studies were mainly retrospective biobanked studies using ELISA platform for measurement of suPAR in batches, which demands manual work and has high processing time.…”

Elevated suPAR Is an Independent Risk Marker for Incident Kidney Disease in Acute Medical Patients

“…In 2013, our hospital began measuring suPAR as a routine biomarker in the emergency department. For acute medical patients, we have previously reported that elevated suPAR at hospital admission is associated with increased rates of surgery (Meyer et al, 2018), future readmission (Rasmussen et al, 2016), and all-cause mortality independent of presenting symptoms (Rasmussen et al, 2018). However, while suPAR has been implicated in many medical conditions, its causal mechanisms have only been investigated in kidney disease.…”