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Availability of suPAR in emergency departments may improve risk stratification: a secondary analysis of the TRIAGE III trial

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@article{6c135169cf444a42abfc4d7a3428b859,
title = "Availability of suPAR in emergency departments may improve risk stratification: a secondary analysis of the TRIAGE III trial",
abstract = "Introduction: Soluble urokinase plasminogen activator receptor (suPAR) is a prognostic and nonspecific biomarker associated with short-term mortality in emergency department (ED) patients. Therefore, the blood level of suPAR might be usable for identification of patients at high- and low risk, shortly after arrival at the ED. Here, we investigate the value of adding suPAR to triage and how this may impact on risk stratification regarding mortality. Methods: The analyses were performed on the TRIAGE III cohort. Patients were triaged in four groups: Red, Orange, Yellow, and Green. Outcome was all-cause mortality within seven days. Discriminative abilities of triage and suPAR on mortality were assessed using the area under the curve (AUC) for receiver operating characteristics (ROC) curves. A suPAR cut-off value was generated using the Youden's index. Patients were subsequently reclassified one triage level up if the suPAR level was above this cut-off and one level down if the suPAR level was below that value. Results: The study included 4420 patients with an available triage category and suPAR measurement. suPAR was significantly better in predicting mortality than triage; AUC (95{\%} confidence interval): 0.85 (0.80-0.89) vs. 0.71 (0.64-0.78), P < 0.001. Combining suPAR and triage yielded an AUC of 0.87 (0.82-0-93). The Youden's cut-off of suPAR was 5.9 ng/mL and reclassified triage using this value resulted in a more accurate risk stratification regarding hospital admission and mortality. Conclusion: Addition of suPAR to triage potentially improves prediction of short-term mortality. Measurement of suPAR in relation to the triage process may allow a more accurate identification of ED patients at risk. Trial registration: Clinicaltrials.gov, NCT02643459. Registered 31 December 2015. https://clinicaltrials.gov/ct2/show/NCT02643459?cond=NCT02643459&rank=1.",
keywords = "Emergency department, Prognostic biomarkers, Risk stratification, suPAR, Triage",
author = "Martin Schultz and Rasmussen, {Line J H} and Thomas Kallemose and Erik Kj{\o}ller and Lind, {Morten N} and Lisbet Ravn and Theis Lange and Lars K{\o}ber and Rasmussen, {Lars S} and Jesper Eugen-Olsen and Kasper Iversen",
year = "2019",
month = "4",
day = "11",
doi = "10.1186/s13049-019-0621-7",
language = "English",
volume = "27",
pages = "43",
journal = "Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine",
issn = "1757-7241",
publisher = "BioMed Central Ltd",
number = "1",

}

RIS

TY - JOUR

T1 - Availability of suPAR in emergency departments may improve risk stratification

T2 - a secondary analysis of the TRIAGE III trial

AU - Schultz, Martin

AU - Rasmussen, Line J H

AU - Kallemose, Thomas

AU - Kjøller, Erik

AU - Lind, Morten N

AU - Ravn, Lisbet

AU - Lange, Theis

AU - Køber, Lars

AU - Rasmussen, Lars S

AU - Eugen-Olsen, Jesper

AU - Iversen, Kasper

PY - 2019/4/11

Y1 - 2019/4/11

N2 - Introduction: Soluble urokinase plasminogen activator receptor (suPAR) is a prognostic and nonspecific biomarker associated with short-term mortality in emergency department (ED) patients. Therefore, the blood level of suPAR might be usable for identification of patients at high- and low risk, shortly after arrival at the ED. Here, we investigate the value of adding suPAR to triage and how this may impact on risk stratification regarding mortality. Methods: The analyses were performed on the TRIAGE III cohort. Patients were triaged in four groups: Red, Orange, Yellow, and Green. Outcome was all-cause mortality within seven days. Discriminative abilities of triage and suPAR on mortality were assessed using the area under the curve (AUC) for receiver operating characteristics (ROC) curves. A suPAR cut-off value was generated using the Youden's index. Patients were subsequently reclassified one triage level up if the suPAR level was above this cut-off and one level down if the suPAR level was below that value. Results: The study included 4420 patients with an available triage category and suPAR measurement. suPAR was significantly better in predicting mortality than triage; AUC (95% confidence interval): 0.85 (0.80-0.89) vs. 0.71 (0.64-0.78), P < 0.001. Combining suPAR and triage yielded an AUC of 0.87 (0.82-0-93). The Youden's cut-off of suPAR was 5.9 ng/mL and reclassified triage using this value resulted in a more accurate risk stratification regarding hospital admission and mortality. Conclusion: Addition of suPAR to triage potentially improves prediction of short-term mortality. Measurement of suPAR in relation to the triage process may allow a more accurate identification of ED patients at risk. Trial registration: Clinicaltrials.gov, NCT02643459. Registered 31 December 2015. https://clinicaltrials.gov/ct2/show/NCT02643459?cond=NCT02643459&rank=1.

AB - Introduction: Soluble urokinase plasminogen activator receptor (suPAR) is a prognostic and nonspecific biomarker associated with short-term mortality in emergency department (ED) patients. Therefore, the blood level of suPAR might be usable for identification of patients at high- and low risk, shortly after arrival at the ED. Here, we investigate the value of adding suPAR to triage and how this may impact on risk stratification regarding mortality. Methods: The analyses were performed on the TRIAGE III cohort. Patients were triaged in four groups: Red, Orange, Yellow, and Green. Outcome was all-cause mortality within seven days. Discriminative abilities of triage and suPAR on mortality were assessed using the area under the curve (AUC) for receiver operating characteristics (ROC) curves. A suPAR cut-off value was generated using the Youden's index. Patients were subsequently reclassified one triage level up if the suPAR level was above this cut-off and one level down if the suPAR level was below that value. Results: The study included 4420 patients with an available triage category and suPAR measurement. suPAR was significantly better in predicting mortality than triage; AUC (95% confidence interval): 0.85 (0.80-0.89) vs. 0.71 (0.64-0.78), P < 0.001. Combining suPAR and triage yielded an AUC of 0.87 (0.82-0-93). The Youden's cut-off of suPAR was 5.9 ng/mL and reclassified triage using this value resulted in a more accurate risk stratification regarding hospital admission and mortality. Conclusion: Addition of suPAR to triage potentially improves prediction of short-term mortality. Measurement of suPAR in relation to the triage process may allow a more accurate identification of ED patients at risk. Trial registration: Clinicaltrials.gov, NCT02643459. Registered 31 December 2015. https://clinicaltrials.gov/ct2/show/NCT02643459?cond=NCT02643459&rank=1.

KW - Emergency department

KW - Prognostic biomarkers

KW - Risk stratification

KW - suPAR

KW - Triage

UR - http://www.scopus.com/inward/record.url?scp=85064221364&partnerID=8YFLogxK

U2 - 10.1186/s13049-019-0621-7

DO - 10.1186/s13049-019-0621-7

M3 - Journal article

VL - 27

SP - 43

JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

SN - 1757-7241

IS - 1

M1 - 43

ER -

ID: 56977345