The Value of SuPAR in Bronchoalveolar Lavage Fluid in Assessing Severity and Prognosis of Severe Community Acquired Pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SunGuangxin ¹ , ShiYanjie ¹ , HouWeipeng ² , XuChao ² ,  ZhangHua ² , RenYingjie ³

1. Department of Pulmonary Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, 450007, China;
2. ;
3. ;

Corresponding author：

ZhangHua, Email: luckzhanghua@163.com

Keywords：

Severe community-acquired pneumonia; Urokinase-type plasminogen activator receptor; Procalcitonin

DOI：

10.7507/1671-6205.2016129

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the clinical value of the soluble urokinase type plasminogen activator receptor (suPAR) level in bronchoalveolar lavage fluid (BALF) for evaluateting the disease severity and prognosis of severe community-acquired pneumonia (SCAP). Methods Eighty-four patients with SCAP were recruited as a SCAP group from the respiratory department, ICU and RICU between April 2014 and April 2016. According to their organ dysfunction, the SCAP patients were subdivided into a MODS group and a non-MODS group. Depending on the treatment response on the 7^th day of treatment, they were subdivided into an effective group and an ineffective group. According to the survival condition within 28 days, they were subdivided into a survival group and a death group. Meanwhile, 50 cases with non-severe common community acquired pneumonia were recruited as a control group. On the admission day, all cases were evaluated by PSI score and APACHE Ⅱscore. The serum suPAR level were detected by ELISA on the 1^st day in hospital. The suPAR and procalcitonin (PCT) levels in the patient's BALF and serum were detected on the 1^st, 3^rd, 7^th day, discharge or death day. The symptoms and signs, biochemical and pulmonary imaging changes were also observed. Results There were no differences in the sex, age, body weight, duration of pneumonia, or complicated diseases such as hypertension, coronary heart disease and cerebral vascular diseases between the SCAP group and the control group (all P > 0.05). The suPAR levels in serum and BALF of the SCAP group were higher than those of the control group with significant differences (all P < 0.05). The suPAR level in BALF was obviously higher than that in serum in the SCAP group with significant difference (P < 0.05), and slightly higher than that in serum in the control group with no significant difference (P > 0.05). The level of suPAR in BALF of the MODS group was significantly higher than that in the non-MODS group with significant difference (P < 0.05), but there was no significant difference in the PCT level between the two groups (P > 0.05). The suPAR level in the ineffective treatment group was significantly higher than that in the effective treatment group on the 7^th day in hospital with significant difference (P < 0.05). The suPAR levels in BALF of the death group were higher than those in the survival group at each time point after admittion with significant difference (all P < 0.05), and the PCT levels had no significant difference between the two groups within 1 week of each time point (all P > 0.05). The suPAR level in BALF of the SCAP group was positively correlated with APACHEⅡ score and PSI score (r=0.578, P=0.0085; r=0.565, P=0.0071), and plasma PCT level was weakly correlated with the APACHEⅡ score and PSI score (r₁=-0.0137, r₂=-0.0152). Conclusion The SuPAR level in BALF of patients with SCAP is closely related to the severity and prognosis, and can be used as an index to assess the severity and prognosis.

Citation： SunGuangxin, ShiYanjie, HouWeipeng, XuChao, ZhangHua, RenYingjie. The Value of SuPAR in Bronchoalveolar Lavage Fluid in Assessing Severity and Prognosis of Severe Community Acquired Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(6): 562-566. doi: 10.7507/1671-6205.2016129 Copy

1.	Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis.Virulence, 2014, 5:4-11.
2.	Sirvent JM, Delatorre MC, Lorencio C, et al. Predictive factors of mortality in severe community-acquired pneumonia:a model with data on the first 24 h of ICU admission. Med Intensiva, 2013, 37:308-315.
3.	Mandell LA, Wunderink RG, Anzueto A, et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis, 2007, 44:27-72.
4.	Lim WS, Smith DL, Wise MP, et al. British Thoracic Society community acquired pneumonia guideline and the NICE pneumonia guideline:how they fit together. BMJ Open Respir Res, 2015, 13:e000091.
5.	Gonzalez C, Johnson T, Rolston K, et al. Predicting pneumonia mortality using CURB-65, PSI, and patient characteristics in patients presenting to the emergency department of a comprehensive cancer center. Cancer Med, 2014, 3:962-970.
6.	Zhou XY, Ben SQ, Chen HL, et al. A comparison of APACHE Ⅱ and CPIS scores for the prediction of 30-day mortality in patients with ventilator-associated pneumonia. Int J Infect Dis, 2015, 30:144-147.
7.	Valencia M, Badia JR, Cavalcanti M, et al. Pneumonia severity index class V patients with community-acquired peunmonia:characteristics, outcomes, and value of seventy scores. Chest, 2007, 132:1515-1522.
8.	文艳, 王红, 罗旭颖.社区获得性肺炎病情严重度与降钙素原、C反应蛋白相关性的研究.临床和实验医学杂志, 2013, 12:1154-1156.
9.	Thuno M, Macho B, Eugen-Olsen J. suPAR:the molecular crystalball. Dis Markers, 2009, 27:157-172.
10.	Savva A, Raftogiannis M, Baziaka F, et al. Soluble leurokinase plasminogen activator receptor (suPAR) for assessment of disease severity in ventilator-associated pneumonia and sepsis. J Infect, 2011, 63:344-350.
11.	Kurtipek GS, Kesli R, Tunçez Akyürek F, et al. Plasma-soluble urokinase plasminogen activator receptor (suPAR) levels in psoriasis patients and correlation with disease severity. Acta Dermatovenerol Alp Pannonica Adriat, 2015, 24:73-75.
12.	Wrotek A, Jackowska T, Pawlik K. Soluble urokinase plasminogen activator receptor:an indicator of pneumonia severity in children. Adv Exp Med Biol, 2015, 1:1-7.
13.	Donadello K, Scolletta S, Covajes C, et al. suPAR as a prognostic biomarker in sepsis. BMC Med, 2012, 10:2-3.
14.	Hoenigl M, Raggam RB, Wagner J, et al. Diagnostic accuracy of soluble urokinase plasminogen activator receptor (suPAR) for prediction of bacteremia in patients with systemic inflammatory response syndrome. Clin Biochem, 2013, 46:225-229.
15.	Backes Y, van der Sluijs KF, Mackie DP, et al. Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection:a systematic review. Intensive Care Med, 2012, 38:1418-1428.
16.	Huttunen R, Syuanen J, Vuento R, et al. Plasma level of soluble urokinase-type plasminogen activator receptor as a predictor of disease severity and case fatality in patients with bacteraemia:a prospective cohort study. J Intern Med, 2011, 270:32-40.

1. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis.Virulence, 2014, 5:4-11.
2. Sirvent JM, Delatorre MC, Lorencio C, et al. Predictive factors of mortality in severe community-acquired pneumonia:a model with data on the first 24 h of ICU admission. Med Intensiva, 2013, 37:308-315.
3. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis, 2007, 44:27-72.
4. Lim WS, Smith DL, Wise MP, et al. British Thoracic Society community acquired pneumonia guideline and the NICE pneumonia guideline:how they fit together. BMJ Open Respir Res, 2015, 13:e000091.
5. Gonzalez C, Johnson T, Rolston K, et al. Predicting pneumonia mortality using CURB-65, PSI, and patient characteristics in patients presenting to the emergency department of a comprehensive cancer center. Cancer Med, 2014, 3:962-970.
6. Zhou XY, Ben SQ, Chen HL, et al. A comparison of APACHE Ⅱ and CPIS scores for the prediction of 30-day mortality in patients with ventilator-associated pneumonia. Int J Infect Dis, 2015, 30:144-147.
7. Valencia M, Badia JR, Cavalcanti M, et al. Pneumonia severity index class V patients with community-acquired peunmonia:characteristics, outcomes, and value of seventy scores. Chest, 2007, 132:1515-1522.
8. 文艳, 王红, 罗旭颖.社区获得性肺炎病情严重度与降钙素原、C反应蛋白相关性的研究.临床和实验医学杂志, 2013, 12:1154-1156.
9. Thuno M, Macho B, Eugen-Olsen J. suPAR:the molecular crystalball. Dis Markers, 2009, 27:157-172.
10. Savva A, Raftogiannis M, Baziaka F, et al. Soluble leurokinase plasminogen activator receptor (suPAR) for assessment of disease severity in ventilator-associated pneumonia and sepsis. J Infect, 2011, 63:344-350.
11. Kurtipek GS, Kesli R, Tunçez Akyürek F, et al. Plasma-soluble urokinase plasminogen activator receptor (suPAR) levels in psoriasis patients and correlation with disease severity. Acta Dermatovenerol Alp Pannonica Adriat, 2015, 24:73-75.
12. Wrotek A, Jackowska T, Pawlik K. Soluble urokinase plasminogen activator receptor:an indicator of pneumonia severity in children. Adv Exp Med Biol, 2015, 1:1-7.
13. Donadello K, Scolletta S, Covajes C, et al. suPAR as a prognostic biomarker in sepsis. BMC Med, 2012, 10:2-3.
14. Hoenigl M, Raggam RB, Wagner J, et al. Diagnostic accuracy of soluble urokinase plasminogen activator receptor (suPAR) for prediction of bacteremia in patients with systemic inflammatory response syndrome. Clin Biochem, 2013, 46:225-229.
15. Backes Y, van der Sluijs KF, Mackie DP, et al. Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection:a systematic review. Intensive Care Med, 2012, 38:1418-1428.
16. Huttunen R, Syuanen J, Vuento R, et al. Plasma level of soluble urokinase-type plasminogen activator receptor as a predictor of disease severity and case fatality in patients with bacteraemia:a prospective cohort study. J Intern Med, 2011, 270:32-40.

Chinese Journal of Respiratory and Critical Care Medicine

The Value of SuPAR in Bronchoalveolar Lavage Fluid in Assessing Severity and Prognosis of Severe Community Acquired Pneumonia

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content