Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker and risk factor for kidney diseases, with a potential prognostic value in critically ill patients. In this monocentric prospective study, we measured plasma suPAR levels immediately after ICU admission in unselected 237 consecutive patients using a turbidimetric assay. Primary objective was the prognostic value for ICU- and 28-day mortality. Secondary objectives were association with sequential organ failure assessment (SOFA) score, coagulation and inflammation markers, AKI-3 and differences in prespecified subgroups. Median suPAR levels were 8.0 ng/mL [25th-75th percentile 4.3–14.4], with lower levels in ICU survivors than non-survivors (6.7 vs. 11.6 ng/mL, p < 0.001). SuPAR levels were higher in COVID-19, kidney disease, moderate-to-severe liver disease, and sepsis. ICU mortality increased by an odds ratio (OR) of 4.7 in patients with the highest compared to lowest quartile suPAR. Kaplan–Meier overall survival estimates at 3 months were 63% and 49%, in patients with suPAR below/above 12 ng/mL (log-rank p = 0.027). Due to an observed interaction between SOFA score and suPAR, we performed a random forest method identifying cutoffs. ICU mortality was 53%, 17% and 2% in patients with a SOFA score > 7, SOFA ≤ 7 & suPAR > 8 ng/mL, and SOFA score ≤ 7 & suPAR ≤ 8 ng/mL, respectively. suPAR was a significant predictor for AKI-3 occurrence (OR per doubling 1.89, 95% CI: 1.20–2.98; p = 0.006). suPAR levels at ICU admission may offer additional value for risk stratification especially in ICU patients with moderate organ dysfunction as reflected by a SOFA score ≤ 7.
【저자키워드】 Infectious diseases, Diagnosis, Prognostic markers, 【초록키워드】 COVID-19, Mortality, Prospective Study, suPAR, 28-day mortality, Sepsis, risk factor, ICU, Coagulation, risk stratification, survival, Patient, ICU admission, organ dysfunction, Kidney disease, SOFA, Kidney diseases, receptor, estimate, moderate, inflammation markers, critically ill patients, association, Inflammatory biomarker, Interaction, Odds ratio, Liver disease, Organ failure, SOFA score, Prognostic value, subgroups, plasma suPAR, doubling, random, offer, survivor, quartile, Kaplan–Meier, ICU patient, non-survivor, lowest, Occurrence, highest, performed, reflected, consecutive patient, Secondary objective, 【제목키워드】 intensive care, suPAR, kidney, Patient, receptor, Critical, predict,