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 firstname.lastname@example.org 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.