Soluble Urokinase Plasminogen Activator Receptor (suPAR) as an Added Predictor to Existing Preoperative Risk Assessments.
Adult
Aged
Aged, 80 and over
Biomarkers
/ blood
C-Reactive Protein
/ metabolism
Female
Health Status
Humans
Male
Middle Aged
Mortality
Postoperative Complications
/ epidemiology
Predictive Value of Tests
Preoperative Period
Proportional Hazards Models
Receptors, Urokinase Plasminogen Activator
/ blood
Risk Assessment
Surgical Procedures, Operative
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
pubmed:
6
11
2018
medline:
25
6
2019
entrez:
4
11
2018
Statut:
ppublish
Résumé
Risk assessment strategies, such as using the American Society of Anesthesiologists (ASA) physical status classification, attempt to identify surgical high-risk patients. Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker reflecting overall systemic inflammation and immune activation, and it could potentially improve the identification of high-risk surgical patients. We included patients acutely admitted to the emergency department who subsequently underwent surgery within 90 days of admission. Patients were stratified into low-risk or high-risk groups, according to ASA classification (ASA During 90-day follow-up from surgery, 31 (7.0%) patients died and 158 (35.6%) patients had postoperative complications. After adjusting for age, sex, and ASA classification, the HR for 90-day postoperative mortality was 2.5 (95% CI 1.6-4.0) for every doubling of suPAR level. suPAR was significantly better than CRP at predicting mortality and all complications (P = 0.0036 and P = 0.0041, respectively). Combining ASA classification and suPAR level significantly improved prediction of mortality and the occurrence of a postoperative complication within 90 days after surgery (P < 0.0001). Measuring suPAR levels in acutely admitted patients may aid in identifying high-risk patients and improve prediction of postoperative complications.
Sections du résumé
BACKGROUND
BACKGROUND
Risk assessment strategies, such as using the American Society of Anesthesiologists (ASA) physical status classification, attempt to identify surgical high-risk patients. Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker reflecting overall systemic inflammation and immune activation, and it could potentially improve the identification of high-risk surgical patients.
METHODS
METHODS
We included patients acutely admitted to the emergency department who subsequently underwent surgery within 90 days of admission. Patients were stratified into low-risk or high-risk groups, according to ASA classification (ASA
RESULTS
RESULTS
During 90-day follow-up from surgery, 31 (7.0%) patients died and 158 (35.6%) patients had postoperative complications. After adjusting for age, sex, and ASA classification, the HR for 90-day postoperative mortality was 2.5 (95% CI 1.6-4.0) for every doubling of suPAR level. suPAR was significantly better than CRP at predicting mortality and all complications (P = 0.0036 and P = 0.0041, respectively). Combining ASA classification and suPAR level significantly improved prediction of mortality and the occurrence of a postoperative complication within 90 days after surgery (P < 0.0001).
CONCLUSION
CONCLUSIONS
Measuring suPAR levels in acutely admitted patients may aid in identifying high-risk patients and improve prediction of postoperative complications.
Identifiants
pubmed: 30390135
doi: 10.1007/s00268-018-4841-1
pii: 10.1007/s00268-018-4841-1
doi:
Substances chimiques
Biomarkers
0
Receptors, Urokinase Plasminogen Activator
0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
780-790Références
J Clin Anesth. 2000 Jun;12(4):328-34
pubmed: 10960208
Anaesth Intensive Care. 2002 Oct;30(5):633-40
pubmed: 12413266
JAMA. 1961 Oct 21;178:261-6
pubmed: 13887881
Br J Anaesth. 2004 Sep;93(3):393-9
pubmed: 15220171
Ann Surg. 2006 May;243(5):636-41; discussion 641-4
pubmed: 16632998
Surg Infect (Larchmt). 2006 Oct;7(5):463-71
pubmed: 17083312
World J Emerg Surg. 2007 Jun 05;2:16
pubmed: 17550623
Qual Saf Health Care. 2008 Jun;17(3):216-23
pubmed: 18519629
Br J Surg. 1991 Mar;78(3):355-60
pubmed: 2021856
J Intern Med. 2010 Sep;268(3):296-308
pubmed: 20561148
Cancer Epidemiol Biomarkers Prev. 2011 Apr;20(4):609-18
pubmed: 21239684
Postgrad Med J. 2011 Aug;87(1030):535-41
pubmed: 21257993
J Intern Med. 2011 Jul;270(1):29-31
pubmed: 21366732
Anesth Analg. 2011 May;112(5):1019-33
pubmed: 21372274
Patient Saf Surg. 2011 May 20;5:13
pubmed: 21599915
Clin Biochem. 2011 Aug;44(12):1021-4
pubmed: 21640092
Eur J Anaesthesiol. 2011 Oct;28(10):742-7
pubmed: 21912242
Ann Surg. 2012 Apr;255(4):696-702
pubmed: 22418007
Ann Surg Oncol. 2012 Dec;19(13):4168-77
pubmed: 22805866
Crit Care. 2012 Jul 23;16(4):R130
pubmed: 22824423
Biochem Med (Zagreb). 2012;22(3):276-82
pubmed: 23092060
Crit Care. 2013 May 07;17(3):226
pubmed: 23672931
Br J Surg. 2014 Mar;101(4):339-46
pubmed: 24311257
Clin Chim Acta. 2015 Feb 20;441:23-8
pubmed: 25499119
Curr Opin Crit Care. 2015 Aug;21(4):328-35
pubmed: 26083327
N Engl J Med. 2015 Nov 12;373(20):1916-25
pubmed: 26539835
Scand J Trauma Resusc Emerg Med. 2015 Dec 01;23:106
pubmed: 26626588
Eur J Clin Invest. 2016 Apr;46(4):305-11
pubmed: 26799247
Ann Surg. 2016 Jul;264(1):23-31
pubmed: 26928465
Ann Surg. 2016 Jul;264(1):10-22
pubmed: 26945154
Ann Surg. 2016 Jun;263(6):1042-8
pubmed: 26954897
Emerg Med J. 2016 Nov;33(11):769-775
pubmed: 27590986
Wound Repair Regen. 2016 Nov;24(6):1036-1040
pubmed: 27759946
Eur J Microbiol Immunol (Bp). 2016 Jul 19;6(3):178-185
pubmed: 27766166
Surg Endosc. 2018 Jun;32(6):2877-2885
pubmed: 29282574
Anesthesiology. 1978 Oct;49(4):239-43
pubmed: 697077
Crit Care Med. 1981 Aug;9(8):591-7
pubmed: 7261642
Anaesthesia. 1995 Mar;50(3):195-9
pubmed: 7717481
Ann Surg. 1994 Jul;220(1):3-9
pubmed: 8024356
J Qual Clin Pract. 1996 Jun;16(2):103-8
pubmed: 8794400
Acta Anaesthesiol Scand. 1996 Aug;40(7):783-91
pubmed: 8874563