The predictive ability of soluble urokinase plasminogen activator receptor for elderly emergency patients.

• Project/Area Number: 20K17910
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 55060:Emergency medicine-related
• Research Institution: Jikei University School of Medicine
• Principal Investigator: Mitsunaga Toshiya 東京慈恵会医科大学, 医学部, 助教 (60838936)
• Project Period (FY): 2020-04-01 – 2023-03-31
• Project Status: Completed (Fiscal Year 2022)
• Budget Amount: ¥2,470,000 (Direct Cost: ¥1,900,000、Indirect Cost: ¥570,000); Fiscal Year 2021: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000); Fiscal Year 2020: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000)
• Keywords: suPAR / prognosis / preventable attendance / mortality / emergency department / Preventable attendance / Mortality / Prognosis / Elderly patients / NEWS / 高齢救急 / 病院前トリアージ / 入院予測 / 死亡予測 / 高齢者 / トリアージ / 予後予測

Outline of Research at the Start

可溶型ウロキナーゼ型プラスミノゲンアクチベータ受容体(suPAR)は、種々の免疫系の活性化を示すマーカーである。suPARは、感染症・悪性腫瘍だけでなく院内死亡のリスクスコアなど、救急医学領域においても注目されている。デンマークではsuPARが75歳以上の高齢者における院内死亡のリスク予測マーカーとして用いられている。本研究では、症状が曖昧でリスク評価が難しい高齢患者の予後を予測するために、在宅医療現場における高齢患者のsuPAR血中濃度と入院率・院内死亡率との関係性を明らかにすることを目的とする。

Outline of Final Research Achievements

49 eligible older patients were included, and thirteen PEA cases were detected and eight patients died. The median suPAR was significantly lower in the PEA group and survivor’s group. The median (interquartile range) suPAR and NEWS were 9.0 ng/mL (5.6) and 4 (4.0). For suPAR, the AUC for the prediction of PEA was 0.678. Furthermore, the AUC for predicting PEA was 0.867 for suPAR + WBC + CRP + NEWS. Similarly, the AUC for the prediction of mortality was 0.805 in suPAR. The AUC of modified suPAR with NEWS for mortality was higher than that of suPAR and 0.865.

Academic Significance and Societal Importance of the Research Achievements

In Japan, the increase number of elderly emergency patients is a serious issue in emergency medicine, and as the results of this study show, if we could predict the unnecessary emergency attendance, it may be possible to alleviate emergency overcrowding in the future.

Research Products

• [Journal Article] The predictive value of modified soluble urokinase plasminogen activator receptor (suPAR) with National Early Warning Score (NEWS) for mortality in emergency elderly patients in Japan: A prospective pilot study (2023)
  • Author(s): Toshiya Mitsunaga, Yuhei Ohtaki, Yutaka Seki, Kunihiro Mashiko, Masahiko Uzura, Kenji Okuno, Satoshi Takeda
  • Journal Title: Acute Medicine & Surgery Volume: -
  • Peer Reviewed / Open Access
• [Journal Article] Ability of combined soluble urokinase plasminogen activator receptor to predict preventable emergency attendance in older patients in Japan: a prospective pilot study (2022)
  • Author(s): Mitsunaga Toshiya、Ohtaki Yuhei、Yajima Wataru、Sugiura Kei、Seki Yutaka、Mashiko Kunihiro、Uzura Masahiko、Takeda Satoshi
  • Journal Title: PeerJ Volume: 10 Pages: e14322-e14322
  • DOI: 10.7717/peerj.14322
  • Peer Reviewed / Open Access