Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Krammer, W.
Influence of renal function on C-reactive protein, procalcitonin and soluble urokinase-type plasminogen activator receptor in patients with systemic inflammatory response syndrome
[ Diplomarbeit ] Medical University of Graz; 2013. pp. 91
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Hönigl Martin
- Krause Robert
- Altmetrics:
- Abstract:
- Background Acute renal failure is a severe and frequent complication in patients with systemic inflammatory response syndrome (SIRS). Early diagnosis of bacteraemia in these patients is important to initiate specific antibiotic therapy as soon as possible which will reduce mortality in patients with SIRS. Recent studies have shown that the biomarker soluble urokinase-type plasminogen activator receptor (suPAR) may predict 30-day mortality in SIRS patients; however limited studies for suPAR are available ¿ contrary to procalcitonin (PCT) ¿ investigating the diagnostic potential to predict bacteraemia in SIRS patients. Aim of this study was to evaluate the diagnostic potential for prediction of bacteraemia and to evaluate the prognostic potential for prediction of 30-day mortality of the biomarkers C-reactive protein (CRP), PCT and suPAR in SIRS patients. Further we investigated the influence of creatinine levels for diagnosing bacteraemia and predicting 30-day mortality of these biomarkers in patients with SIRS. Methods Five hundred ninety-five patients presenting symptoms of SIRS at the emergency room between November 2010 and November 2012 were enrolled in this prospective cohort study at the Hospital of the Medical University of Graz, Austria. Blood cultures and serum samples (for determination of CRP, PCT, suPAR, and creatinine) were simultaneously taken and clinical and demographic data were collected. Receiver Operating Characteristic (ROC) curves were performed and Area under the curve (AUC) values were calculated for patients with a glomerular filtration rate (GFR) above 60mL/min and for patients with a GFR lower 60mL/min to predict bacteraemia/30-day mortality. Cut-off points according to the highest Youden Index were calculated for PCT and suPAR to predict 30-day mortality in the whole study population. Results In 438 (73,6%) patients blood culture turned positive. CRP, PCT and suPAR levels were significantly higher in patients with a GFR lower 60mL/min. A positive correlation was found between creatinine and PCT (r=0,480; p<0,001) and between creatinine and suPAR (r=0,472; p<0,001). To a lesser extend a correlation was found between creatinine and CRP (r=0,251; p<0,001). For prediction of bacteraemia the AUC-value for PCT in patients with a GFR higher 60mL/min was 0,690 (CI 0,604-0,775) and for patients with a GFR lower 60mL/min 0,736 (CI 0,662-0,810). The AUC-values for CRP and suPAR in patients with a GFR higher 60mL/min (CRP: AUC 0,504; CI 0,422-0,585; suPAR: AUC 0,616; CI 0,566-0,744) were comparable to the AUC-values for CRP and suPAR in patients with a GFR lower 60mL/min (CRP: AUC 0,540; CI 0,468-0,612; suPAR: AUC 0,651; CI 0,584-0,718). For prediction of 30-day mortality in patients with a GFR higher 60mL/min AUC-values were as follows: CRP (AUC 0,538; CI 0,472-0,650), PCT( AUC 0,622; CI 0,495-0,749) and suPAR (AUC 0,642; CI 0,513-0,770). AUC-values for patients with a GFR lower 60mL/min were as follows: CRP (AUC 0,570; CI 0,494-0,650), PCT (AUC 0,670; CI 0,583-0,753) und suPAR (AUC 0,744; CI 0,677-0,822). PCT (cut-off 0,6ng/ml; sensitivity 86%, specificity 47%) revealed an odds-ratio of 5,423 (CI 2.4872-11.8282; p<0,001) and suPAR (cut-off 9,2ng/ml; sensitivity 66%, specificity 72%) revealed an odds-ratio of 4,816 (CI 2.832-8.189; p<0,001) for prediction of 30-day mortality in the whole study population. Conclusion We found that PCT and suPAR levels correlate with creatinin levels in SIRS patients. Initial PCT levels and to a lesser extend suPAR levels may predict bacteraemia in patients with SIRS independent of renal function. SuPAR, independent of renal function, is superior compared to PCT to predict 30-day mortality in SIRS patients. CRP does not have the ability either to diagnose bacteraemia or to predict 30-day mortality in patients with SIRS.