Correlation of plasma suPAR expression with disease risk and severity as well as prognosis of sepsis-induced acute respiratory distress syndrome

Abstract

The aim of this study was to investigate the association of plasma suPAR expression with disease risk and severity as well as prognosis of sepsis-induced acute respiratory distress syndrome (ARDS). 162 ARDS patients were consecutively enrolled in this study and categorized into sepsis-induced ARDS group (N=104) or non-sepsis-induced ARDS group (N=58) according to the cause of ARDS. Disease severity was evaluated as mild, moderate and severe disease based on lowest PaO₂/FiO₂ ratio. Acute Physiology and Chronic Health Evaluation (APACHE) II as well as Sequential Organ Failure Assessment (SOFA) scores were calculated. Serum procalcitonin (PCT) was detected by electro chemiluminescence immunoassay, and plasma suPAR was determined by enzyme-linked immunosorbent assay. Sepsis-induced ARDS presented with elevated plasma suPAR level (P<0.001), serum PCT level (P<0.001), APACHE II score (P<0.001) and SOFA score (P<0.001) compared with patients with non-sepsis-induced ARDS. Plasma suPAR level was positively correlated with disease severity (P<0.001), PCT level (P<0.001), APACHE II score (P<0.001) and SOFA score (P<0.001). Among 104 sepsis-induced ARDS patients, 73 cases survived (survival group) while other 31 cased dies (non-survival group). Plasma suPAR level was greatly increased in non-survival group compared to survival group (P<0.001). Furthermore, ROC curve analysis illustrated that suPAR level presented good diagnostic value in predicting mortality with AUC 0.81 (95% CI: 0.73-0.89). Plasma suPAR is increased in sepsis-induced ARDS patients, and it correlates with higher disease severity and unfavorable prognosis.

Keywords: Sepsis; acute respiratory distress syndrome (ARDS); disease severity; prognosis; suPAR.

Figure 1

Study flow.

Figure 2

Correlation of plasma suPAR level with disease severity. Plasma suPAR level was increased in sepsis-induced ARDS patients with higher disease severity (P<0.001).

Figure 3

Correlation of plasma suPAR level with PCT, APACHE II score and SOFA score. Plasma suPAR level was positively correlated with PCT level (A), APACHE II score (B) and SOFA score (C) in sepsis-induced ARDS patients.

Figure 4

SuPAR correlated with higher mortality. In sepsis-induced ARDS patients, plasma suPAR level was increased in non-survivals compared with survivals (A), and ROC curve illuminated that suPAR level presented with good predictive value for mortality (B).