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

Herlev Hospital20,000 enrolled

Overview

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

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

20,000

Conditions

Triage Risk Stratification With Biomarker

Interventions

suPAR measurementBEHAVIORAL

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.

Eligibility

Sex: ALLMin age: 16 Years

Medical Language ↔ Plain English

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.

Locations (1)

Herlev Hospital, Department of Cardiology

Herlev, Denmark

Outcomes

Primary Outcomes

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.

Time frame: 10 months after the inclusions period ends mortality data will be assessed

Secondary Outcomes

All Cause Mortality

Mortality within 30 days

Time frame: 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

Time frame: 24 hours

Number of Admissions to the Medical Ward

Number of Participants with Admissions to the Medical War

Time frame: 30 days

Number of Patients With an Admission to the Intensive Care Unit

Number of Participants with transfer to the ICU

Time frame: 30 days

Number of Patients With New Cancer Diagnosis in Control vs Intervention Groups

Time frame: 10 months after inclusion period ends

Length of Stay During Admission.

Length of stay in days during the admission

Time frame: 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.

Data from ClinicalTrials.gov

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