Urokinase plasminogen activator receptor (uPAR) is embedded in the cell membranes of leukocytes. Its soluble counterpart, suPAR, has been reported as a marker of severity and unfavorable outcome in a variety of diseases www.selleckchem.com/products/Romidepsin-FK228.html ranging from certain types of cancer to infectious diseases [3-5]. Recent studies with limited numbers of patients with bacteremia or sepsis are most relevant to this study and suggest that suPAR may inform about the risk of death [6,7]. However, in these studies, suPAR is not superior to APACHE II.The present study aimed to develop and evaluate a new prognostication score of the risk for death in sepsis by using suPAR to improve information provided by the APACHE II score. To this end, one prospective cohort of patients enrolled by 39 departments participating in the Hellenic Sepsis Study Group [8] was studied.

Results were confirmed in a second independent cohort of sepsis patients prospectively enrolled in an ICU in Sweden.Materials and methodsStudy designThis prospective multicenter study was conducted in 39 departments across Greece from January 2008 to December 2010. The participating departments were 15 ICUs, 18 departments of internal medicine, two departments of pulmonary medicine, three departments of surgery, and one department of urology.Sepsis patients admitted to the emergency department and sepsis patients presenting during hospitalization in the general ward or in the ICU were eligible. Written informed consent was provided by the patients or by first-degree relatives of patients unable to provide consent.

The study protocol was approved by the ethics committees of the participating hospitals. Each patient was enrolled once.Inclusion criteria were (a) age of at least 18 years; (b) diagnosis of sepsis, severe sepsis, or septic shock; (c) sepsis due to one of the following infections: community-acquired pneumonia (CAP), hospital-acquired Brefeldin_A pneumonia, ventilator-associated pneumonia, acute pyelonephritis, intra-abdominal infection, or primary bacteremia; and (d) blood sampling within 24 hours from the presentation of signs of sepsis. Six study sites (two ICUs, three departments of internal medicine, and one department of surgery) were selected to be representative of the total enrolment study sites, and agreed to repeat blood sampling on days 3, 7, and 10. First sampling was always done before the administration of any treatment. Exclusion criteria were HIV infection and neutropenia, which was defined as less than 1,000 neutrophils/mm3.Patients were classified according to standard definitions of sepsis, severe sepsis, and septic shock [9]. Infections were defined according to standard definitions [10-14]. For each patient, a complete diagnostic work-up was performed.