Tue Jun 21 2022

suPAR in the Emergency Department: A Tool for the Assessment of Elderly Patients

The nonspecific prognostic biomarker suPAR successfully predicts all-cause 30-day mortality in all age groups.

Conclusion

The study results show that patients in the emergency department (ED) had significantly higher levels of suPAR, particularly among the elderly. However, there was no correlation between age, suPAR levels, and 30-day mortality risk. Patients with high suPAR concentrations faced a greater risk of mortality and a lower chance of ED discharge. As a general prognostic marker in the ED, suPAR effectively forecasts 30-day mortality across all age groups and retains its predictive accuracy alongside other common risk evaluation tools. Low suPAR levels can safely support the decision to discharge patients from the ED without increasing the risk of adverse outcomes.

For everyone arriving at the ED, the most appropriate suPAR cut-off value is 4 ng/mL. Meanwhile, for older adults, a cut-off of 5 ng/mL could be a viable option. The study advises against using a 6 ng/mL cut-off value. It confirms that suPAR enhances risk assessment for elderly patients and those whom current risk stratification methods overlook, particularly since these patients often demand significant time and resources in the ED.

Discussion

This study assessed the value of suPAR, a nonspecific prognostic biomarker, in stratifying risk in emergency department (ED) patients, with a focus on the elderly. It builds on previous findings that suPAR levels predict outcomes effectively: higher levels suggest an increased risk of death within 30 days of admission, while lower levels indicate a higher likelihood of discharge and survival within the same timeframe. This relationship holds true across all ages. However, adding an interaction between suPAR levels and age did not significantly enhance predictive models.

The research confirms suPAR’s role as an independent predictor of 30-day mortality, even after adjusting for age, NEWS scores, CRP levels, and comorbidities like diabetes, cardiovascular, and neurological diseases. Nevertheless, its predictive strength diminishes when adjusted with multiple factors.

Analysis showed that suPAR levels rise with age, with the median level in the elderly (5.4 ng/mL) significantly higher than in the overall (4.1 ng/mL) and younger populations (3.7 ng/mL). Despite higher median levels in the elderly, a 6 ng/mL suPAR cut-off would increase mortality risk, suggesting that lower thresholds (4 ng/mL for the general population and 5 ng/mL for the elderly) better predict outcomes without compromising safety.

The study highlights that while suPAR values increase with both chronic and acute conditions, its nonspecific nature means it should complement, not replace, other assessment tools in ED decision-making. This approach could improve patient management by guiding admission or discharge decisions more effectively.

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published suPAR studies in leading medical journals

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