Risk Stratification in Acute Care: The Meaning of suPAR Measurement in Triage

Study Overview
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Brief Summary
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Will clinical outcome for patients be improved if triage in Acute wards and Emergency rooms is supplemented with a prognostic biomarker?

Detailed Description
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In a health care system where the general population is growing, more patients are living with chronic conditions and the hospitals are reducing beds and length of stay, it is crucial to perform safe and fast risk stratification of patients presenting in the Emergency departments. Risk stratification is currently performed with a combination of measurement of the vital signs and assessment of the primary complaint. The aim of the current study is to assess whether the supplement of biomarkers can improve the risk stratification in regard to mortality, readmissions and improve overall patient flow in the Emergency departments. Soluble urokinase plasminogen activating receptor (suPAR) is the soluble form of urokinase-type plasminogen activator receptor (uPAR). uPAR is present on various immunological active cells, as well as endothelia and smooth muscle cells. It is believed that suPAR mirrors the inflammatory response in patients. Previous studies have shown a strong association with mortality and severity of disease in a broad variety of conditions (infection, hepatic-, renal-, cardiac- and lung disease) as well as a possible marker of disease development in the general population. These abilities indicate that suPAR although unspecific would be ideal to identify patients at high- and at low-risk. The aim is to target interventions and limited clinical focus where it is most beneficial. In unselected patients suPAR is one of the strongest prognostic biomarker available to date. It is not known whether information on prognosis in the Emergency department can be used to prevent death, serious complications or reduce admissions and readmissions. The purpose of the current study is to examine if introduction of the biomarker suPAR and education of doctors in the meaning of suPAR levels and association to disease, can reduce mortality, admissions and readmission in patients referred to the emergency rooms.

Official Title
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Introduction of Soluble Urokinase Plasminogen Activating Receptor in Acute Care as a Prognostic Biomarker to Strengthen Risk Stratification of Acutely Admitted Patients

Conditions
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Triage, Risk Stratification With Biomarker

Intervention / Treatment
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* Behavioral: suPAR measurement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients presenting acutely to the Acute ward/Emergency department and have blood samples done which include both Hemoglobin, C reactive protein and Creatinine within 6 hours of registration within the study period. The study is carried out in 2 Hospitals in the Capital of Denmark. Exclusion Criteria: Patients presenting in Pediatric, Gynecological or Obstetric units. Patients not being examined with blood samples.

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Conventional<br>no suPAR measurement. Standard care. | |
| Experimental: suPAR<br>suPAR measurement and education of doctors working in the Emergency department in the meaning of low or elevated levels of suPAR. Since suPAR is measured on all patients regardless of disease the investigators cannot define a single intervention. A possible intervention depends on the clinical situation. | Behavioral: suPAR measurement<br>* The biomarker suPAR will be measured on all patients included in the study. Before the study period the doctors will receive information on suPAR. We want to study if the information provided by suPAR is useful in emergency medicine. Interventions depends on the clinical issue, as suPAR is an unspecific marker of disease. Usually a elevated suPAR level could result in more investigation e.g. diagnostic procedures or follow up, while a low suPAR could result in faster discharge.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All Cause Mortality | Time frame starts at the beginning of the index admission, defined as first admission in the study period. Patients will be followed using central registers. | 10 months after the inclusions period ends mortality data will be assessed | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All Cause Mortality | Mortality within 30 days | 1 months after index admission mortality data will assessed | 
| Number of Discharges From the Emergency Room Within 24 Hours | How many patients are discharged directly from the ED | 24 hours | 
| Number of Admissions to the Medical Ward | Number of Participants with Admissions to the Medical War | 30 days | 
| Number of Patients With an Admission to the Intensive Care Unit | Number of Participants with transfer to the ICU | 30 days | 
| Number of Patients With New Cancer Diagnosis in Control vs Intervention Groups |  | 10 months after inclusion period ends | 
| Length of Stay During Admission. | Length of stay in days during the admission | 30 days | 
| Number of Readmissions | Patients will be followed using central registers. All new admissions within 90 days of the same patient is defined as readmissions. | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute care, Triage, Risk stratification, suPAR