Improving prognostication of pneumonia among elderly patients: usefulness of suPAR.

ABSTRACT

PURPOSE: Elderly patients with suspected pneumonia represent a significant proportion of hospital admissions, which is a prognostic challenge for physicians. Our research aimed to assess the prognosis of patients with pneumonia using soluble urokinase plasminogen activator receptor (suPAR) combined with clinical data. METHODS: In a prospective observational study including 164 patients > 65 years (mean age 84.2 (+/-7.64) years) who were hospitalized for a suspicion of pneumonia, suPAR was assessed for each patient, as was the prognosis score (PSI, CURB65) and inflammatory biomarkers (C-reactive protein, procalcitonin, white blood cells). The prognostic value of the suPAR for 30-day mortality was assessed using receiver operating characteristic (ROC) curve analyses. Optimal cut-offs with corresponding sensitivity (SE) and specificity (SP) were determined using the Youden index. RESULTS: A suPAR > 5.1 ng/mL was predictive of 30-day mortality with a sensitivity of 100% and a specificity of 40.4%. A combination of the following parameters exhibited an SE of 100% (95% CI, 100-100) for an SP value of 64.9% (95% CI, 57.6-72.2) when at least two of them were above or below the following cut-off threshold values suPAR > 9.8 ng/mL, BMI < 29.3 kg/m2 and PSI > 106.5. CONCLUSION: The suPAR seems to be a promising biomarker that can be combined with the PSI and BMI to improve the prognosis of pneumonia among elderly patients. Prospective studies with larger populations are needed to confirm whether this new approach can improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov (NCT02467192), 27th may 2015.

The prognosis of pneumonia in geriatric patients remain challenging, can the dosage of suPAR help clinicians determine the prognosis of pneumonia among geriatric patients? The use of individual or clinical parameters should be improved for a better prediction of respiratory complications and mortality. Adding suPAR dosage with PSI and BMI provides the best sensitivity and specificity for 30-day mortality.