Urine suPAR Levels Compared with Plasma suPAR Levels as Predictors of Post-consultation Mortality Risk Among Individuals
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Urine suPAR Levels Compared with Plasma suPAR Levels as Predictors of Post-consultation Mortality Risk Among Individuals Assumed to be TB-negative: A Prospective Cohort Study Paulo Rabna,1 Andreas Andersen,1 Christian Wejse,1,2 Ines Oliveira,1,3 Victor Francisco Gomes,1 Maya Bonde Haaland,3 Peter Aaby,1,4 and Jesper Eugen-Olsen3,5
Abstract—Plasma levels of the inflammatory biomarker soluble urokinase plasminogen activator (suPAR) have been shown to carry prognostic information in various infectious and inflammatory diseases. The present study aimed to compare the prognostic value of urine suPAR (U-suPAR) to that of plasma suPAR (P-suPAR), thereby exploring the possibility of replacing the blood sample with an easy obtainable urine sample. We enrolled 1,007 adults, older than 15 years of age, with a negative TB diagnosis between April 2004 and December 2006. Levels of U-suPAR and PsuPAR were available in 863 individuals. U-suPAR was measured using a commercial ELISA (suPARnostic®). We found that U-suPAR carried significant prognostic information on mortality for HIV-infected subjects with an area under the ROC curve of 0.75. For HIV-negative individuals, little or no prognostic effect was observed. However, in both HIV positives and negatives, the predictive effect of U-suPAR was found to be inferior to that of P-suPAR. KEY WORDS: aTBneg; U-suPAR; P-suPAR; mortality; prognostic; Guinea-Bissau.
Acid Fast Bacilli and have normal X-ray. These individuals are sent home without TB treatment. We term these individuals “assumed TB negative” (aTBneg). We have recently documented that the aTBneg individuals in the current study had a seven times higher mortality rate at 3 months of follow-up compared with the general population and that P-suPAR carries prognostic information on mortality among the aTBneg individuals [1]. Several studies have shown that an elevated plasma level of soluble urokinase plasminogen activator (PsuPAR) is associated with an increased mortality rate in individuals with infectious diseases, including HIV-1 [2, 3], active TB [4] and sepsis [5, 6] as well as in individuals with cardiovascular disease [7] and cancer[8]. P-suPAR levels positively correlate with pro-inflammatory biomarkers such as TNF-α and leukocyte counts [9] and with Creactive protein levels [10] and are thought to reflect the degree of inflammation and immune activation [3, 11]. SuPAR has been found in urine samples of healthy individuals, cancer patients and HIV-1-infected patients
BACKGROUND Tuberculosis (TB) is an ancient disease, which continues to pose a major public health challenge. Upon a positive diagnosis of active TB, a 6–8-month treatment regime is initiated to cure the patient. Less focus have been on individuals coming to the health centres presenting respiratory symptoms consistent with TB but who are diagnosed negative for TB, i.e. have negative sputum results on direct microscopy for
1
Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau 2 Department of infectious Diseases, Aarhus Univers
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