Soluble urokinase plasminogen activator receptor and lactate as prognostic biomarkers in patients presenting with non-specific chief complaints in the pre-hospital setting - the PRIUS-study.
- Resource Type
- Academic Journal
- Authors
- Ivic R; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. robert.ivic@ki.se.; Academic Emergency Medical Service, Region Stockholm, Stockholm, Sweden. robert.ivic@ki.se.; Nurmi J; Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.; Kurland L; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.; Department for Medical Sciences, Örebro University, Örebro, Sweden.; Vicente V; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.; Lindström V; Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, division of nursing, Stockholm, Sweden.; Samariten Ambulance Stockholm, Stockholm, Sweden.; Djärv T; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.; Kaartinen J; Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.; Castrén M; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.; Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.; Bohm K; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
- Source
- Publisher: BioMed Central Country of Publication: England NLM ID: 101477511 Publication Model: Electronic Cited Medium: Internet ISSN: 1757-7241 (Electronic) Linking ISSN: 17577241 NLM ISO Abbreviation: Scand J Trauma Resusc Emerg Med Subsets: MEDLINE
- Subject
- Language
- English
Background: Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with NSCs often have normal vital signs. It has previously been established that NSCs may have a serious underlying condition that has yet to be identified. The aim of the current study was to determine if soluble urokinase plasminogen activator receptor (suPAR) and lactate could be used to identify serious conditions among patients presenting with NSCs to the EMS. The secondary aim was to describe the prognostic value for mortality in the group.
Method: A blinded prospective observational cohort study was conducted of patients brought to the ED by ambulance after calling the national emergency number 112 and who were assessed as having NSC by the EMS. Biomarkers were measured during index EMS assessment before transportation to the ED. Patients were followed via EMS and hospital electronic health records. Descriptive and logistic regression analyses were used.
Results: A total of 414 patients were included, with a median age of 82 years. A serious condition was present in 15.2% of the patients. Elevated suPAR above 3 ng/ml had a positive likelihood ratio (LR+) of 1.17 and a positive predictive value (PPV) of 17.3% as being predictive of a prevalent serious condition. Elevated suPAR above 9 ng/ml had LR+ 4.67 and a PPV of 16.7% as being predictive of 30-day mortality. Lactate was not significantly predictive.
Conclusion: Pre-hospital suPAR and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the ED among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment.
Trial Registration: NCT03089359. Registered 20 March 2017, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03089359 .
(© 2021. The Author(s).)