suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19

Izzet Altintas; Jesper Eugen-Olsen; Santeri Seppälä; Jens Tingleff; Marius Ahm Stauning; Nora Olsen El Caidi; Sanaá Elmajdoubi; Hejdi Gamst-Jensen; Mette B. Lindstrøm; Line Jee Hartmann Rasmussen; Klaus Tjelle Kristiansen; Christian Rasmussen; Jan O. Nehlin; Thomas Kallemose; Harri Hyppölä; Ove Andersen

doi:10.1177/11772719211034685

suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19

Izzet Altintas^*, Jesper Eugen-Olsen, Santeri Seppälä, Jens Tingleff, Marius Ahm Stauning, Nora Olsen El Caidi, Sanaá Elmajdoubi, Hejdi Gamst-Jensen, Mette B. Lindstrøm, Line Jee Hartmann Rasmussen, Klaus Tjelle Kristiansen, Christian Rasmussen, Jan O. Nehlin, Thomas Kallemose, Harri Hyppölä, Ove Andersen

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

17 Citations (Scopus)

14 Downloads (Pure)

Abstract

Objectives: Elevated soluble urokinase Plasminogen Activator Receptor (suPAR) is a biomarker associated with adverse outcomes. We aimed to investigate the associations between plasma suPAR levels (testing the cut-offs ⩽4, 4-6, and ⩾6 ng/mL) with risk of 14-day mortality, and with the risk of mechanical ventilation in patients that tested positive for SARS-CoV-2. Methods: Observational cohort study of patients presenting with symptoms of COVID-19 at Department of Emergency Medicine, Amager and Hvidovre Hospital, Denmark from March 19th, 2020 to April 3rd, 2020. Plasma suPAR was measured using suPARnostic technologies. Patients were followed for development of mechanical ventilation and mortality for 14 days. Validation of our findings were carried out in a similar sized COVID-19 patient cohort from Mikkeli Central Hospital, Finland. Results: Among 386 patients with symptoms of COVID-19, the median (interquartile range) age was 64 years (46-77), 57% were women, median suPAR was 4.0 ng/mL (2.7-5.9). In total, 35 patients (9.1%) died during the 14 days follow-up. Patients with suPAR ⩽4 ng/mL (N = 196; 50.8%) had a low risk of mortality (N = 2; 1.0%; negative predictive value of 99.0%, specificity 55.3%, sensitivity 95.2%, positive predictive value 17.4%). Among patients with suPAR ⩾6 ng/mL (N = 92; 23.8%), 16 died (17.4%). About 99 patients (25.6%) tested positive for SARS CoV-2 and of those 12 (12.1%) developed need for mechanical ventilation. None of the SARS-CoV-2 positive patients with suPAR ⩽4 ng/mL (N = 28; 38.8%) needed mechanical ventilation or died. The Mikkeli Central Hospital validation cohort confirmed our findings concerning suPAR cut-offs for risk of development of mechanical ventilation and mortality. Conclusions: Patients with symptoms of COVID-19 and suPAR ⩽4 or ⩾6 ng/mL had low or high risk, respectively, concerning the need for mechanical ventilation or mortality. We suggest cut-offs for identification of risk groups in patients presenting to the ED with symptoms of or confirmed COVID-19.

Original language	English
Journal	Biomarker Insights
Volume	16
Pages (from-to)	1-12
ISSN	1177-2719
DOIs	https://doi.org/10.1177/11772719211034685
Publication status	Published - 2021

Bibliographical note

Publisher Copyright:
© The Author(s) 2021.

Keywords

biomarker
COVID-19
mechanical ventilation
Prognosis
suPAR

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10.1177/11772719211034685Licence: CC BY-NC

suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19Final published version, 468 KBLicence: CC BY-NC

Cite this

Altintas, I., Eugen-Olsen, J., Seppälä, S., Tingleff, J., Stauning, M. A., El Caidi, N. O., Elmajdoubi, S., Gamst-Jensen, H., Lindstrøm, M. B., Rasmussen, L. J. H., Kristiansen, K. T., Rasmussen, C., Nehlin, J. O., Kallemose, T., Hyppölä, H., & Andersen, O. (2021). suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19. Biomarker Insights, 16, 1-12. https://doi.org/10.1177/11772719211034685

suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19. / Altintas, Izzet; Eugen-Olsen, Jesper; Seppälä, Santeri; Tingleff, Jens; Stauning, Marius Ahm; El Caidi, Nora Olsen; Elmajdoubi, Sanaá; Gamst-Jensen, Hejdi; Lindstrøm, Mette B.; Rasmussen, Line Jee Hartmann; Kristiansen, Klaus Tjelle; Rasmussen, Christian; Nehlin, Jan O.; Kallemose, Thomas; Hyppölä, Harri; Andersen, Ove.

In: Biomarker Insights, Vol. 16, 2021, p. 1-12.

Research output: Contribution to journal › Journal article › Research › peer-review

Altintas, I, Eugen-Olsen, J, Seppälä, S, Tingleff, J, Stauning, MA, El Caidi, NO, Elmajdoubi, S, Gamst-Jensen, H, Lindstrøm, MB, Rasmussen, LJH, Kristiansen, KT, Rasmussen, C, Nehlin, JO, Kallemose, T, Hyppölä, H & Andersen, O 2021, 'suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19', Biomarker Insights, vol. 16, pp. 1-12. https://doi.org/10.1177/11772719211034685

Altintas, Izzet ; Eugen-Olsen, Jesper ; Seppälä, Santeri ; Tingleff, Jens ; Stauning, Marius Ahm ; El Caidi, Nora Olsen ; Elmajdoubi, Sanaá ; Gamst-Jensen, Hejdi ; Lindstrøm, Mette B. ; Rasmussen, Line Jee Hartmann ; Kristiansen, Klaus Tjelle ; Rasmussen, Christian ; Nehlin, Jan O. ; Kallemose, Thomas ; Hyppölä, Harri ; Andersen, Ove. / suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19. In: Biomarker Insights. 2021 ; Vol. 16. pp. 1-12.

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title = "suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19",

abstract = "Objectives: Elevated soluble urokinase Plasminogen Activator Receptor (suPAR) is a biomarker associated with adverse outcomes. We aimed to investigate the associations between plasma suPAR levels (testing the cut-offs ⩽4, 4-6, and ⩾6 ng/mL) with risk of 14-day mortality, and with the risk of mechanical ventilation in patients that tested positive for SARS-CoV-2. Methods: Observational cohort study of patients presenting with symptoms of COVID-19 at Department of Emergency Medicine, Amager and Hvidovre Hospital, Denmark from March 19th, 2020 to April 3rd, 2020. Plasma suPAR was measured using suPARnostic technologies. Patients were followed for development of mechanical ventilation and mortality for 14 days. Validation of our findings were carried out in a similar sized COVID-19 patient cohort from Mikkeli Central Hospital, Finland. Results: Among 386 patients with symptoms of COVID-19, the median (interquartile range) age was 64 years (46-77), 57% were women, median suPAR was 4.0 ng/mL (2.7-5.9). In total, 35 patients (9.1%) died during the 14 days follow-up. Patients with suPAR ⩽4 ng/mL (N = 196; 50.8%) had a low risk of mortality (N = 2; 1.0%; negative predictive value of 99.0%, specificity 55.3%, sensitivity 95.2%, positive predictive value 17.4%). Among patients with suPAR ⩾6 ng/mL (N = 92; 23.8%), 16 died (17.4%). About 99 patients (25.6%) tested positive for SARS CoV-2 and of those 12 (12.1%) developed need for mechanical ventilation. None of the SARS-CoV-2 positive patients with suPAR ⩽4 ng/mL (N = 28; 38.8%) needed mechanical ventilation or died. The Mikkeli Central Hospital validation cohort confirmed our findings concerning suPAR cut-offs for risk of development of mechanical ventilation and mortality. Conclusions: Patients with symptoms of COVID-19 and suPAR ⩽4 or ⩾6 ng/mL had low or high risk, respectively, concerning the need for mechanical ventilation or mortality. We suggest cut-offs for identification of risk groups in patients presenting to the ED with symptoms of or confirmed COVID-19.",

keywords = "biomarker, COVID-19, mechanical ventilation, Prognosis, suPAR",

author = "Izzet Altintas and Jesper Eugen-Olsen and Santeri Sepp{\"a}l{\"a} and Jens Tingleff and Stauning, {Marius Ahm} and {El Caidi}, {Nora Olsen} and Sana{\'a} Elmajdoubi and Hejdi Gamst-Jensen and Lindstr{\o}m, {Mette B.} and Rasmussen, {Line Jee Hartmann} and Kristiansen, {Klaus Tjelle} and Christian Rasmussen and Nehlin, {Jan O.} and Thomas Kallemose and Harri Hypp{\"o}l{\"a} and Ove Andersen",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2021.",

year = "2021",

doi = "10.1177/11772719211034685",

language = "English",

volume = "16",

pages = "1--12",

journal = "Biomarker Insights",

issn = "1177-2719",

publisher = "Libertas Academica Ltd.",

}

TY - JOUR

T1 - suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19

AU - Altintas, Izzet

AU - Eugen-Olsen, Jesper

AU - Seppälä, Santeri

AU - Tingleff, Jens

AU - Stauning, Marius Ahm

AU - El Caidi, Nora Olsen

AU - Elmajdoubi, Sanaá

AU - Gamst-Jensen, Hejdi

AU - Lindstrøm, Mette B.

AU - Rasmussen, Line Jee Hartmann

AU - Kristiansen, Klaus Tjelle

AU - Rasmussen, Christian

AU - Nehlin, Jan O.

AU - Kallemose, Thomas

AU - Hyppölä, Harri

AU - Andersen, Ove

PY - 2021

Y1 - 2021

N2 - Objectives: Elevated soluble urokinase Plasminogen Activator Receptor (suPAR) is a biomarker associated with adverse outcomes. We aimed to investigate the associations between plasma suPAR levels (testing the cut-offs ⩽4, 4-6, and ⩾6 ng/mL) with risk of 14-day mortality, and with the risk of mechanical ventilation in patients that tested positive for SARS-CoV-2. Methods: Observational cohort study of patients presenting with symptoms of COVID-19 at Department of Emergency Medicine, Amager and Hvidovre Hospital, Denmark from March 19th, 2020 to April 3rd, 2020. Plasma suPAR was measured using suPARnostic technologies. Patients were followed for development of mechanical ventilation and mortality for 14 days. Validation of our findings were carried out in a similar sized COVID-19 patient cohort from Mikkeli Central Hospital, Finland. Results: Among 386 patients with symptoms of COVID-19, the median (interquartile range) age was 64 years (46-77), 57% were women, median suPAR was 4.0 ng/mL (2.7-5.9). In total, 35 patients (9.1%) died during the 14 days follow-up. Patients with suPAR ⩽4 ng/mL (N = 196; 50.8%) had a low risk of mortality (N = 2; 1.0%; negative predictive value of 99.0%, specificity 55.3%, sensitivity 95.2%, positive predictive value 17.4%). Among patients with suPAR ⩾6 ng/mL (N = 92; 23.8%), 16 died (17.4%). About 99 patients (25.6%) tested positive for SARS CoV-2 and of those 12 (12.1%) developed need for mechanical ventilation. None of the SARS-CoV-2 positive patients with suPAR ⩽4 ng/mL (N = 28; 38.8%) needed mechanical ventilation or died. The Mikkeli Central Hospital validation cohort confirmed our findings concerning suPAR cut-offs for risk of development of mechanical ventilation and mortality. Conclusions: Patients with symptoms of COVID-19 and suPAR ⩽4 or ⩾6 ng/mL had low or high risk, respectively, concerning the need for mechanical ventilation or mortality. We suggest cut-offs for identification of risk groups in patients presenting to the ED with symptoms of or confirmed COVID-19.

AB - Objectives: Elevated soluble urokinase Plasminogen Activator Receptor (suPAR) is a biomarker associated with adverse outcomes. We aimed to investigate the associations between plasma suPAR levels (testing the cut-offs ⩽4, 4-6, and ⩾6 ng/mL) with risk of 14-day mortality, and with the risk of mechanical ventilation in patients that tested positive for SARS-CoV-2. Methods: Observational cohort study of patients presenting with symptoms of COVID-19 at Department of Emergency Medicine, Amager and Hvidovre Hospital, Denmark from March 19th, 2020 to April 3rd, 2020. Plasma suPAR was measured using suPARnostic technologies. Patients were followed for development of mechanical ventilation and mortality for 14 days. Validation of our findings were carried out in a similar sized COVID-19 patient cohort from Mikkeli Central Hospital, Finland. Results: Among 386 patients with symptoms of COVID-19, the median (interquartile range) age was 64 years (46-77), 57% were women, median suPAR was 4.0 ng/mL (2.7-5.9). In total, 35 patients (9.1%) died during the 14 days follow-up. Patients with suPAR ⩽4 ng/mL (N = 196; 50.8%) had a low risk of mortality (N = 2; 1.0%; negative predictive value of 99.0%, specificity 55.3%, sensitivity 95.2%, positive predictive value 17.4%). Among patients with suPAR ⩾6 ng/mL (N = 92; 23.8%), 16 died (17.4%). About 99 patients (25.6%) tested positive for SARS CoV-2 and of those 12 (12.1%) developed need for mechanical ventilation. None of the SARS-CoV-2 positive patients with suPAR ⩽4 ng/mL (N = 28; 38.8%) needed mechanical ventilation or died. The Mikkeli Central Hospital validation cohort confirmed our findings concerning suPAR cut-offs for risk of development of mechanical ventilation and mortality. Conclusions: Patients with symptoms of COVID-19 and suPAR ⩽4 or ⩾6 ng/mL had low or high risk, respectively, concerning the need for mechanical ventilation or mortality. We suggest cut-offs for identification of risk groups in patients presenting to the ED with symptoms of or confirmed COVID-19.

KW - biomarker

KW - COVID-19

KW - mechanical ventilation

KW - Prognosis

KW - suPAR

U2 - 10.1177/11772719211034685

DO - 10.1177/11772719211034685

M3 - Journal article

C2 - 34421295

AN - SCOPUS:85112725814

VL - 16

SP - 1

EP - 12

JO - Biomarker Insights

JF - Biomarker Insights

SN - 1177-2719

ER -