Predictive value of plasma soluble urokinase-type plasminogen activator receptor for post-severe traumatic multiple organ dysfunction syndrome

Abstract

Objective To investigate the predictive value of plasma soluble urokinase-type plasminogen activator receptor (suPAR) for post-severe traumatic multiple organ dysfunction syndrome (MODS). Methods A total of 108 patients suffering from severe trauma admitted to the Trauma Center of our hospital from December 2019 to December 2020 were enrolled. Venous blood samples were collected at admission and plasma suPAR concentration was measured by ELISA, and their demographic and clinical data were collected. The patients were divided into MODS group and non-MODS group according to the sequential organ failure assessment(SOFA) within 14 d after admission. The general data and variables such as suPAR, white blood cell (WBC) count, and injury severity score (ISS) were compared between the 2 groups. Logistic regression analysis was used to screen the independent predictors for post-traumatic MODS, and receiver operating characteristic (ROC) curve was adopted to evaluate the predictive value of the variables. Results Age, rate of comorbidity, ISS, suPAR at admission, rate of shock, rate of infection and rate of surgery were significantly higher in the MODS group than the non-MODS group [52.6±14.1 vs 46.1±14.1 years old, 29.4% vs 9.5%, 29 (25, 33) vs 26 (21, 30) points, 6.7±2.7 vs 5.0±2.1 ng/mL, 41.2% vs 17.6%, 61.8% vs 24.3%, 52.9% vs 32.4%, P < 0.05]. There were no significant differences in sex, injury cause, injury site, WBC count, and rate of blood purification between the 2 groups. Multivariate Logistic regression analysis showed that comorbidity, ISS, suPAR, and infection were independent predictors for post-traumatic MODS (P < 0.05). ROC curve analysis indicated that the area under the curve (AUC) of suPAR for predicting post-traumatic MODS was 0.704 (P < 0.05). When the cutoff value was 5.04 ng/mL, the sensitivity was 73.5% and the specificity was 62.2%. The AUC of ISS was 0.632 (P < 0.05), and the sensitivity was 73.5% and the specificity was 58.1% when the cutoff value was 26. Conclusion The plasma suPAR level at admission can predict the occurrence of post-traumatic MODS in patients with severe trauma. Early monitoring of suPAR has a certain value in evaluation of inflammation and immune activation in the body and in guidance of clinical evaluation and treatment.

Keywords

• severe trauma
• soluble urokinase-type plasminogen activator receptor
• multiple organ dysfunction syndrome
• predictive value