suPAR interpretation made easier- a decision guidelines for the daily use of suPAR in ED

The difficulty of triaging often increases when clinical signs and symptoms are subtle or unspecific. However, it is in the professional’s hands to make the best possible decision regarding the patient. To base the decision on more indicators, biomarkers are introduced to better screen the risk disease worsening for patients with subtle or unspecific signs.

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A powerful biomarker is suPAR, a non-specific marker associated with a high predictive value for unfavorable outcomes. The levels have been suggested to mirror the degree of immune system activation and disease progression.

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In the study conducted by the Hellenic Sepsis Study Group, the panel of experts suggested guidelines for the daily use of suPAR in the ED. Moreover, the study highlights important statements regarding the utility of suPAR for ED patients.

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• Levels < 4?ng/ml?support?discharge?of the patient admitted to the ED after a thorough clinical evaluation.
• Levels > 6 ng/ml are an alarming sign of risk for unfavorable outcomes, but they need to be interpreted in light of the patient's history.
• Levels between 4 and 6?ng/ml need to be interpreted in light of the patient's history of comorbidities, which may increase them, such as rheumatoid arthritis, solid tumor malignancy, and chronic renal disease.
• Levels > 12?ng/ml in critically ill patients are prognostic of 28-day mortality?ranging between 17 and 50%, depending on the APACHE II score.
• Levels > 12?ng/ml in a patient with suspicion of infection?and one sign of the qSOFA score?may indicate sepsis?and an unfavorable outcome.
• No strong evidence is available yet to support using suPAR as a surrogate tool for antimicrobial stewardship.

It is important to remember that suPAR levels must be interpreted individually considering the history of malignancy or chronic renal disease since this may lead to increased baseline values.?