The diagnostic and prognostic significance of soluble urokinase plasminogen activator receptor in systemic inflammatory response syndrome
Introduction
Sepsis is a clinical syndrome defined as a systemic response to infection and one of the major causes of mortality and morbidity in hospitals [1], [2]. Diagnosing sepsis is further complicated because clinical and laboratory signs often appear similar to other non-infectious causes of systemic inflammation. Clinical and laboratory signs of systemic inflammation, including changes in body temperature > 38 °C or < 36 °C, heart rate > 90 beats/min, hyperventilation (respiratory rate > 20 breaths/min), or PaCO2 < 32 mm Hg, white blood cell count > 12 × 109/L, or < 4 × 109/L, >10% immature neutrophils, are sensitive. The co-presence of two or more of these clinical and laboratory sign criteria is defined as systemic inflammatory response syndrome (SIRS) [3]. SIRS is generally used in the infection identification, though infection is not always present in SIRS patients. This makes it particularly difficult to accurately identify sepsis patients in good time. There is therefore a need for reliable biomarkers to help with sepsis diagnosis. C-reactive protein (CRP) and procalcitonin (PCT) are currently used on a routine basis [4], [5], [6]. Soluble urokinase-type plasminogen activator receptor (suPAR) has recently been reported as a potential biomarker for infection diseases [6]. Urokinase-type plasminogen activator receptor is expressed on neutrophils, lymphocytes, macrophages, endothelial and malignant cells. suPAR is a soluble form of the urokinase-type plasminogen activator receptor [7].
The aim of this study was to determine the predictive role of suPAR, PCT and CRP values in the differential diagnosis and prognosis of SIRS patients.
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Materials and methods
The study was performed between January and June, 2009, at the Karadeniz Technical University Medical Faculty Hospital in Turkey. Patients with at least two of the systemic inflammatory response syndrome (SIRS) criteria defined in 1992 [temperature > 38 °C or < 36 °C, heart rate > 90 beats/min, respiratory rate > 20 breaths/min, or PaCO2 < 32 mm Hg, white blood cell count > 12 × 109/L or < 4 × 109/L or >10% immature neutrophils] were enrolled. A control group made up healthy blood donors was established.
Statistical analysis
Descriptive statistics was performed for all the studied variables. The data obtained in measurements of the normal distribution were analyzed using the Kolmogorov–Smirnov test. Data in conformity with normal distribution were analyzed using Student's t-test, and those not conforming to normal distribution using the Mann Whitney-U test. Data obtained by measurements were given as mean ± standard deviation. Data obtained by counting were given as numbers (%); analyses were performed using the
Results
Eighty-five consecutive patients with SIRS, 31 female and 54 male, with a mean age of 53.4 ± 13.3, were included in this study. Bacteremia was determined in 44 patients in the SIRS group, urinary tract infection (UTI) in 20, pneumonia in 12 and no infection in nine. Fifty-three subjects were enrolled in the control group, of whom 20 were female and 33 male, with a mean age of 28.1 ± 6.6. A suPAR value of 10.2 ± 6.6, PCT of 10.8 ± 22.9 and CRP 13.1 ± 10.6 were determined in the SIRS patients, compared to
Discussion
suPAR is a new biomarker, and there have as yet been few studies on the subject. Studies have reported that plasma suPAR levels rise in patients with sepsis, stating that suPAR emission increases during acute inflammation [7], [8]. Concentrations of suPAR increase in conditions that involve immune activation, and studies have shown that high concentrations of suPAR portend a poor clinical outcome in such diverse infections as tuberculosis, malaria, HIV infection, Crimean–Congo hemorrhagic fever
References (22)
- et al.
The plasma level of soluble urokinase receptor is elevated in patients with Streptococcus pneumoniae bacteraemia and predicts mortality
Clin Microbiol Infect
(2004) - et al.
Enzyme-linked immunoabsorbent assay detection of a soluble form of urokinase plasminogen activator receptor in vivo
Blood
(1995) - et al.
The diagnostic and prognostic significance of soluble urokinase plasminogen activator receptor in Crimean-Congo hemorrhagic fever
J Clin Virol
(2011) - et al.
Release of urokinase plasminogen activator receptor during urosepsis and endotoxemia
Kidney Int
(2001) - et al.
Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery
Br J Anaesth
(2005) - et al.
Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients
Am J Respir Crit Care Med
(2003) - et al.
The epidemiology of sepsis in the United States from 1979 through 2000
N Engl J Med
(2003) - et al.
Toward resolving the challenges of sepsis diagnosis
Clin Chem
(2004) Biomarkers of sepsis: clinically useful?
Curr Opin Crit Care
(2005)
Use of plasma C-reactive protein, procalcitonin, neutrophils, macrophage migration inhibitory factor, soluble urokinase-type plasminogen activator receptor, and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections: a prospective study
Crit Care
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I have no conflict of interest and received no financial support.