Contribution of SuPAR for patients in a situation of uncertainty downstream of emergencies

Abstract

Objectives: Evolution is difficult to predict for some patients at emergency department (ED). The soluble urokinase plasminogen activator receptor (suPAR) is a non-specific prognostic inflammatory blood biomarker with a high negative predictive value for pejorative outcomes. The aim of this study was to investigate the relationship between low levels of suPAR at ED admission and patient discharge following hospitalization in a short stay unit.

Methods: We carried out a single-center prospective observational study in the acute-care hospital ward of a university hospital center, including patients over 18 years old with an intermediate triage score.

Results: Overall, 202 acute medical patients were included, exhibiting a mean suPAR level of 7.43 ± 3.36 μg/L. Of these patients, 25 (12.4 %) displayed a suPAR dosage below 4 μg/L and 177 (87.6 %) a dosage ≥4 μg/L. At 24 h, 55 patients (27.2 %) were discharged, 139 (68.8 %) were hospitalized, and five (2.5 %) were either admitted to intensive care or died. In contrast to group with a high suPAR rate, those with suPAR <4 μg/L benefited from secure ED discharge (OR=5.68; CI 95 %=2.6-12.4). For predicting hospital discharge, patients with a suPAR value <4 μg/L had an AUC-ROC of 0.75. (95% CI 0.67-0.83).

Conclusions: Our study revealed that in patients with a high triage scale level and requiring a monitoring period, SuPAR levels under 4 μg/L could have enabled five times more patients to return home compared with those exhibiting a level ≥4 μg/L at emergency visit.

Keywords: discharge; emergency; outcome; suPAR rate.