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Using suPAR as a clinical aid

Current triage methods does not reliably discriminate between patients with good and poor outcomes [1], the scores that have been developed are time consuming and cumbersome to compile so a fast easy-to-use test is a clear need for aid with triage decisions.

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Figure 1 Koch A. & Tacke F, 2012

Specific Emergency Department triage systems including the Australasian Triage Scale (Australia), Manchester Triage System (UK), Canadian Triage and Acuity Scale (Canada) or Emergency Severity Index (USA) have been introduced. Moreover, various laboratory biomarkers are routinely used in medical patients in the ED. However, many of these tools require a specific diagnosis, which may not be immediately obtainable, or have limitations in predicting the expected course of disease including the case fatality rate [2,3].

In September 2012 Koch & Tacke, 2012 put forward their theory about how the amount of suPAR in blood measurements from patients can be used as a tool to prioritize emergency patients [3]. Uusitalo-Seppälä and co-workers conducted a large single-centre prospective study including 539 consecutive patients with suspected infection, in which suPAR was measured at admission to the ED [4]. suPAR levels were strong predictors of 28-day, 90-day and even 1-year case fatality and allowed a better risk stratification compared to classical inflammatory markers such as procalcitonin, interleukin-6 or C-reactive protein [4]. Serum suPAR at a cut-off level of 6.4 ng/mL (reference value for healthy volunteers < 4 ng/mL [5]), showed 76% sensitivity and 69% specificity for fatal disease within 28 days (Fig. 1b).

Koch and Tacke, 2012 continues "A similar prognostic cut-off value of suPAR serum concentration could be applicable to all medical patients in the ED, even those without suspected infection, which would indeed make risk stratification in the ED's suPAR' easy" [3].

1: Challen K., Evaluation of triage methods used to select patients with suspected pandemic influenza for hospital admission. Emerg Med J. 2012 May;29(5):383-8.
2:Challen K & Goodacre SW.Predictive scoring in non-trauma emergency patients: as coping review. Emerg Med J. 2011;28:827–37.
3: Koch A. & Tacke F, Editorial Comment: Risk stratification and triage in the emergency department: has this become 'suPAR' easy? J Intern Med. 2012, 272; 243–246.
3: Uusitalo-Seppälä R et al., Soluble urokinase-type plasminogen activator receptor in patients with suspected infection in the emergency room: a prospective cohort study, J Intern Med. 2012 Sep;272(3):247-56.
5: Eugen-Olsen J. et al. suPAR – a future risk marker in bacteremia, J Intern Med. 2011;270:29–31.

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