• Marius Ahm Stauning, Izzet Altintas, Thomas Kallemose, Jesper Eugen-Olsen, Mette Bendtz Lindstrøm, RasmussenLine Jee HartmannLJHDepartment of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Psychology and Neuroscience, Duke University, Durham, North Carolina., Hejdi Gamst-Jensen, Jan O Nehlin, Ove Andersen, and Jens Tingleff.
• Department of Emergency Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.
• J Emerg Med. 2021 Sep 1; 61 (3): 298313298-313.

BackgroundSevere acute respiratory syndrome coronavirus 2 (The Covid-19 pandemic) strains health care capacity. Better risk stratification, with discharge of patients with a predicted mild disease trajectory, can ease this burden. Elevated blood-soluble urokinase plasminogen activator receptor (suPAR) has previously been shown to be associated with risk of intubation in confirmed COVID-19 patients.ObjectiveTo evaluate whether point-of-care measures of suPAR in patients presenting to the emergency department (ED) with symptoms of COVID-19 can identify patients that can be safely discharged.MethodsObservational cohort study including all patients in the ED with symptoms of COVID-19 from March 19 to April 3, 2020. SuPAR was measured at first presentation. Review of electronic patient records 14 days after admission was used to assess disease trajectory. Primary endpoints were mild, moderate, severe, or very severe trajectory. The predictive value of suPAR, National Early Warning Score (NEWS), C-reactive protein (CRP), and duration of symptoms was calculated using receiver operating characteristics (ROC).ResultsOf 386 patients, 171 (44%) had a mild disease trajectory, 79 (20%) a moderate, 63 (16%) a severe, and 73 (19%) a very severe disease trajectory. Low suPAR was a strong marker of mild disease trajectory. Results suggest a cut-off for discharge for suPAR < 2.0 ng/mL if suPAR is used as a single parameter, and <3.0 ng/mL when combined with NEWS ≤ 4 and CRP < 10 mg/L.ConclusionsuPAR is a potential biomarker for triage and safe early discharge of patients with COVID-19 symptoms in the ED. suPAR can be used even before SARS-CoV-2 status is known.Copyright © 2021 Elsevier Ltd. All rights reserved.

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