Soluble Urokinase Plasminogen Activator Receptor as a Decision Marker for Early Discharge of Patients with COVID-19 Symptoms in the Emergency Department
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Soluble Urokinase Plasminogen Activator Receptor as a Decision Marker for Early Discharge of Patients with COVID-19 Symptoms in the Emergency Department. / Stauning, Marius Ahm; Altintas, Izzet; Kallemose, Thomas; Eugen-Olsen, Jesper; Lindstrøm, Mette Bendtz; Rasmussen, Line Jee Hartmann; Gamst-Jensen, Hejdi; Nehlin, Jan O.; Andersen, Ove; Tingleff, Jens.
I: Journal of Emergency Medicine, Bind 61, Nr. 3, 2021, s. 298-313.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Soluble Urokinase Plasminogen Activator Receptor as a Decision Marker for Early Discharge of Patients with COVID-19 Symptoms in the Emergency Department
AU - Stauning, Marius Ahm
AU - Altintas, Izzet
AU - Kallemose, Thomas
AU - Eugen-Olsen, Jesper
AU - Lindstrøm, Mette Bendtz
AU - Rasmussen, Line Jee Hartmann
AU - Gamst-Jensen, Hejdi
AU - Nehlin, Jan O.
AU - Andersen, Ove
AU - Tingleff, Jens
N1 - Publisher Copyright: © 2021 Elsevier Ltd
PY - 2021
Y1 - 2021
N2 - Background: Severe acute respiratory syndrome coronavirus 2 (The Covid-19 pandemic) strains health care capacity. Better risk stratification, with discharge of patients with a predicted mild disease trajectory, can ease this burden. Elevated blood-soluble urokinase plasminogen activator receptor (suPAR) has previously been shown to be associated with risk of intubation in confirmed COVID-19 patients. Objective: To evaluate whether point-of-care measures of suPAR in patients presenting to the emergency department (ED) with symptoms of COVID-19 can identify patients that can be safely discharged. Methods: Observational cohort study including all patients in the ED with symptoms of COVID-19 from March 19 to April 3, 2020. SuPAR was measured at first presentation. Review of electronic patient records 14 days after admission was used to assess disease trajectory. Primary endpoints were mild, moderate, severe, or very severe trajectory. The predictive value of suPAR, National Early Warning Score (NEWS), C-reactive protein (CRP), and duration of symptoms was calculated using receiver operating characteristics (ROC). Results: Of 386 patients, 171 (44%) had a mild disease trajectory, 79 (20%) a moderate, 63 (16%) a severe, and 73 (19%) a very severe disease trajectory. Low suPAR was a strong marker of mild disease trajectory. Results suggest a cut-off for discharge for suPAR < 2.0 ng/mL if suPAR is used as a single parameter, and <3.0 ng/mL when combined with NEWS ≤ 4 and CRP < 10 mg/L. Conclusion: suPAR is a potential biomarker for triage and safe early discharge of patients with COVID-19 symptoms in the ED. suPAR can be used even before SARS-CoV-2 status is known.
AB - Background: Severe acute respiratory syndrome coronavirus 2 (The Covid-19 pandemic) strains health care capacity. Better risk stratification, with discharge of patients with a predicted mild disease trajectory, can ease this burden. Elevated blood-soluble urokinase plasminogen activator receptor (suPAR) has previously been shown to be associated with risk of intubation in confirmed COVID-19 patients. Objective: To evaluate whether point-of-care measures of suPAR in patients presenting to the emergency department (ED) with symptoms of COVID-19 can identify patients that can be safely discharged. Methods: Observational cohort study including all patients in the ED with symptoms of COVID-19 from March 19 to April 3, 2020. SuPAR was measured at first presentation. Review of electronic patient records 14 days after admission was used to assess disease trajectory. Primary endpoints were mild, moderate, severe, or very severe trajectory. The predictive value of suPAR, National Early Warning Score (NEWS), C-reactive protein (CRP), and duration of symptoms was calculated using receiver operating characteristics (ROC). Results: Of 386 patients, 171 (44%) had a mild disease trajectory, 79 (20%) a moderate, 63 (16%) a severe, and 73 (19%) a very severe disease trajectory. Low suPAR was a strong marker of mild disease trajectory. Results suggest a cut-off for discharge for suPAR < 2.0 ng/mL if suPAR is used as a single parameter, and <3.0 ng/mL when combined with NEWS ≤ 4 and CRP < 10 mg/L. Conclusion: suPAR is a potential biomarker for triage and safe early discharge of patients with COVID-19 symptoms in the ED. suPAR can be used even before SARS-CoV-2 status is known.
KW - Covid-19
KW - CRP
KW - Early discharge
KW - Early warning score
KW - ED overcrowding
KW - Point-of-care test
KW - suPAR
KW - Triage
U2 - 10.1016/j.jemermed.2021.03.012
DO - 10.1016/j.jemermed.2021.03.012
M3 - Journal article
C2 - 34092446
AN - SCOPUS:85108234526
VL - 61
SP - 298
EP - 313
JO - The Journal of Emergency Medicine (Philadelphia)
JF - The Journal of Emergency Medicine (Philadelphia)
SN - 0736-4679
IS - 3
ER -
ID: 273649580