Study On The Application Value Of Plasma Soluble Urokinase-type Plasminogen Activator Receptor In The Emergency Evaluation Of Severe Trauma

BackgroundTrauma is a major health problem facing the world today,especially the severe trauma caused by high-energy injuries,with a high rate of disability and fatality,which poses a great threat to people’s life and health.After the occurrence of trauma,due to a variety of injury mechanisms and high injury energy,the trauma of patients is often complex and serious.Acute posttraumatic reactions such as shock,hypothermia,acid-base imbalance,and organ and system damage often lead to a sudden increase in the severity and risk of the patient’s condition.Even for patients who have survived the immediate and very early death at the scene,the body will be bound to experience severe immune responses and inflammatory reactions,which may cause serious complications such as multiple organ dysfunction syndrome(MODS)and increase the risk of death in the later stage of trauma.Therefore,under the premise of preventing the occurrence of severe trauma,rapid and accurate assessment of the overall condition of trauma patients,early prediction,identification,and intervention of posttraumatic MODS has always been a hot topic in the field of emergency trauma.As a new biomarker reflecting the degree of inflammation and immune activation,soluble urokinase-type plasminogen activator receptor(suPAR)plays a good role in disease indication,organ function evaluation,and prognosis prediction in many diseases.It can also help to improve the early risk stratification of patients in the emergency department.However,in severe trauma characterized by the local and systemic immune responses and inflammatory response,the role of suPAR in evaluating the severity of the posttraumatic condition is rarely reported,and the relationship between suPAR and inflammation-related complications such as MODS after trauma is not clear.Therefore,this study is aimed to explore the application value of suPAR and scoring systems in the emergency evaluation of severe trauma by detecting the level of plasma suPAR in patients and describing the relationship between suPAR and the severity of the posttraumatic condition and posttraumatic MODS,and to provide new supplements for existing evaluation methods.MethodsPatients with severe trauma admitted to the emergency department of our hospital from December 2019 to December 2020 were prospectively included.After admission,venous blood was collected to detect plasma suPAR concentration,and demographic and clinical data were collected at the same time.The(new)injury severity score [(N)ISS],admission modified early warning score(MEWS),acute physiology and chronic health evaluation(APACHE)Ⅱ on first24 h,and sequential organ failure assessment(SOFA)were calculated.The patients were divided into the critical group and the general group according to the first-day APACHE Ⅱ and SOFA.The general data,suPAR,scores,and complications of the two groups were compared.Multivariate Logistic regression analysis was used to determine the independent predictors of critical condition,and the receiver operating characteristic(ROC)curve was drawn to determine the evaluation value of each variable.Then,the patients were divided into the MODS group and the non-MODS group according to the SOFA within 14 days after admission.The general data,suPAR,scores,complications,and treatment of the two groups were compared.Multivariate Logistic regression analysis was used to determine the independent predictors of MODS,and the ROC curve was drawn to analyze the predictive value of each variable.ResultsA total of 108 patients with severe trauma were included.Within 24 hours after admission,35 patients were in critical condition(32.4%).The comorbidity rate,admission suPAR,ISS,NISS,MEWS,shock rate,infection rate,and MODS rate in the critical group were significantly higher than those in the general group [25.7% vs 11.0%,6.9 ± 2.6 ng/m L vs 4.9 ± 2.0 ng/m L,29(26,34)vs 26(20.5,29.5),34(34,41)vs 33(27,36),4(3,5)vs 2(1,3),45.7% vs 15.1%,57.1% vs 26.0%,77.1% vs 9.6%;P < 0.05].Multivariate Logistic regression analysis showed that suPAR,NISS,and MEWS were independent predictors of a critical condition after severe trauma,and when used alone,the area under the curve(AUC)was 0.736(95%CI 0.643 ～ 0.816,P < 0.001)、0.698(95%CI 0.602 ～ 0.782,P < 0.001)and 0.814(95%CI 0.728 ～ 0.883,P <0.001),respectively.The AUC of suPAR combined with NISS was 0.829(95%CI 0.744 ～ 0.895,P < 0.001),combined with MEWS was 0.849(95%CI 0.767 ～ 0.911,P < 0.001),and combined with NISS and MEWS was 0.876(95%CI 0.799 ～ 0.932,P < 0.001).34 patients developed MODS within 14 days after admission(31.5%).The age,comorbidity rate,admission suPAR,ISS,NISS,MEWS,first-day APACHE Ⅱ,shock rate,infection rate,and surgery rate in the MODS group were significantly higher than those in the non-MODS group [52.6 ± 14.1 y vs 46.1 ± 14.1 y,29.4% vs 9.5%,6.7 ± 2.7 ng/m L vs 5.0 ± 2.1ng/m L,29(25,33)vs 26(21,30),34(34,41)vs 33.5(27,36),4(3,5)vs 2(1,3),14.1 ± 5.7 vs6.8 ± 3.7,41.2% vs 17.6%,61.8% vs 24.3%,52.9% vs 32.4%;P < 0.05].Multivariate Logistic regression analysis showed that comorbidity,infection,admission suPAR,and NISS were independent predictors of posttraumatic MODS when using ISS and NISS;and age,infection,suPAR,and MEWS were independent predictors when MEWS was added;and first-day APACHE II and infection were independent predictors when using APACHE Ⅱ.ROC curve analysis showed that the AUC of suPAR,NISS,MEWS,and APACHE Ⅱ alone for predicting MODS was 0.704(95%CI 0.608 ～ 0.788,P < 0.001),0.658(95%CI 0.561 ～ 0.747,P = 0.003),0.758(95%CI 0.666 ～ 0.835,P < 0.001),and 0.853(95%CI 0.772 ～ 0.914,P < 0.001),respectively.The AUC of suPAR combined with NISS was 0.769(95%CI 0.678 ～ 0.845,P <0.001),and combined with age and MEWS was 0.812(95%CI 0.725 ～ 0.880,P < 0.001).Conclusions1.The detection of plasma suPAR after severe trauma can further evaluate the severity of the condition.Patients with high levels of suPAR have more serious physiological conditions after trauma and are more likely to have complications such as shock and infection.Su PAR in combination with NISS,with MEWS,and with NISS and MEWS can improve the effectiveness of evaluating.However,given the simple parameters of MEWS and the ease to obtain clinically,it is recommended to use suPAR combined with MEWS for emergency evaluation of patients with severe trauma.2.The level of plasma suPAR in the early stage of severe trauma can be used as an independent predictor of MODS in the later stage of trauma.Su PAR combined with NISS,and combined with MEWS and age can further improve the predictive value.Although the efficacy of combination is slightly lower than that of APACHE Ⅱ,APACHE Ⅱ has a wide range of parameters and is time-consuming,so suPAR combined with MEWS and age is still the preferred combination for prediction of posttraumatic MODS in the emergency department.3.In clinical application of the variables discussed in this study,it should be noted that infection is an independent high-risk factor for posttraumatic MODS,so active prevention,monitoring,and intervention should be taken appropriately.Besides,factors such as age and comorbidity should also be paid attention to in trauma assessment.4.The single-center study,limited sample size,and only one suPAR test may lead to an insufficient exploration of the clinical value of suPAR in this study.Therefore,larger multicenter studies are needed to further explore the application value of suPAR in the emergency evaluation of patients with severe trauma.