emergency and critical care
Sponsored
suPAR in the ED: Should they
stay or should they go now?
The biomarker soluble urokinase plasminogen activator receptor is a strong measure of chronic
inflammation and underlying risk of negative patient outcomes including short-term mortality
ViroGates
Denmark
For more information,
or to request a free trial
in clinical use, visit
www.virogates.com
or contact
[email protected]
Triage is the process of quickly assessing and
prioritising patients according to urgency and
need for treatment. Emergency departments (EDs)
often use different risk scoring systems in use for
this purpose.
Widely used triage algorithms most often rely
on vital signs and the presenting complaint and
to a lesser extent clinical assessment. In addition
to vital signs, some hospitals use laboratory tests
for aiding in the decision of whether to admit or
discharge the patient.
Now there is a new biomarker highly suited for
risk evaluation in acute medical patients. The
prognostic biomarker is named suPAR (soluble
urokinase Plasminogen Activator Receptor) and
it is a strong measure of chronic inflammation
and underlying risk of negative outcomes
including short-term (in-hospital, 30- and 90-days)
mortality.
In 2013, Copenhagen University Hospital
Hvidovre, Denmark, was the first hospital to
include suPAR as a routine biomarker measured
suPAR patient-flow guideline
Walk in
Ambulance
Emergency
department
56%
suPAR ≤3ng/ml
• Little risk of life-
threatening disease
• Supports the
decision of discharge
Triage
32%
suPAR 3–6ng/ml
• Diseased patients
• Supports that the
patient is diseased
GP
suPAR median (IQR): 2.8
ng/ml (1.9-4.3). n=17,312
acute medical patients
from Danish hospital
12%
suPAR >6ng/ml
• High risk of
life-threatening disease
• Severe disease
• Disease progression
• Underlying illness?
• Clinical attention
6
HHE 2018 | hospitalhealthcare.com
on all acute medical patients. Today, more than
30,000 measurements later, it has become clear
that suPAR is superior to other biomarkers in risk
prediction. Also, many patients may have low CRP
(< 10mg/ml) but still high suPAR – and a high risk
of mortality.
Because suPAR is an unspecific biomarker
elevated by most, if not all, diseases and correlated
to disease severity, a low suPAR level is a safe
indicator for a good prognosis and therefore used
for discharge decisions. More than half of the
acute medical patients will have a suPAR level
below 3ng/ml, and use of the suPAR biomarker
lowers the risk of admitting patients who do not
require hospital admission.
The suPAR test is an aid to EDs in prioritising
patient care. “Increased health care spending is
a tremendous challenge for healthcare systems
worldwide. suPAR helps clinicians in their daily
decision making in connection with admission
or discharge of patients. This way, the healthcare
systems can allocate resources more effectively”,
says Jakob Knudsen, CEO, ViroGates, Denmark.
He continues: “On a global scale, the total
healthcare savings by using suPARnostic ® are
tremendous. Our clinical customers use
suPARnostic ® to secure that discharge decisions
are taken on an informed basis, and to assure
that only patients who do need urgent care are
admitted.”
The Figure shows the guideline for suPAR in
acute medical patients. Of particular clinical
interest is the low suPAR (<3ng/ml; more than
50% of patients) which supports the decision
to discharge the patient – and the high suPAR
(>6ng/ml; around 12% of the patients) where
clinical attention and further investigation is
recommended.
The scientific evidence for use of suPAR is
strong. More than 500 publications covering
a range of disease areas can be found on
pubmed.com, supporting suPAR as a strong
and independent risk biomarker, even after
adjustment for other known factors, such as
vital signs, comorbidities and biomarkers.
The measurement of suPAR can be carried out
using the suPARnostic ® CE/IVD approved product
line. It includes a Lateral Flow Quick Test
(suPARnostic ® Quick Triage) which takes only
20 minutes to carry out, Automated suPARnostic ®
ELISA, or Turbidimetry (suPARnostic ® TurbiLatex)
for simultaneously determination with other
biomarkers.