A comparative analysis of serial measurements of Soluble Urokinase-type Plasminogen Activator Receptor (suPAR) and C-reactive protein in patients with moderate COVID-19: a single center study from India

Abstract

Soluble urokinase plasminogen-activator receptor (suPAR) is a secreted protein associated with inflammation and proven its usefulness in triage/risk stratifications. This prospective study aimed to evaluate the utility of suPAR in comparison to C-reactive protein (CRP) in hospitalized moderate COVID-19 patients.This is a prospective comparative study during second pandemic wave. Serum suPAR level and CRP were measured serially in 31 confirmed COVID-19 hospitalized patients (20 males, 11 females) on day-1 (24-hours of admission), day-3 and day-5 using suPARnostic AUTO flex ELISA and Nephelometry (ThermoFischer) respectively. Schapiro Wilk test verified the data distribution; Wilcoxon signed rank test compared CRP and suPAR between deceased/alive subject and identified link between co-morbidity and COVID-19 severity.In our study, the mean age was 61.8 ranging from 28-82 with 9.7% (n=3/31) mortality rate. Deceased patients showed significant higher suPAR levels correlating with increasing severity from day 1 to 5 (p<0.016-0.006) than CRP (p=0.717). Patients with pre-existing co-morbidities showed significantly elevated suPAR levels on days 1-5, especially those with hypertension (HTN;p<0.03) and chronic kidney disease (CKD;p<0.001).In conclusion, levels of suPAR were higher in deceased patients with severe symptoms of COVID-19 during hospitalization and in patients with pre-existing co-morbid conditions, HTN and CKD. This preliminary study provides evidence suggesting that circulating suPAR can be a potential biomarker to assess the severity of COVID 19 compared to CRP.

Prediction value of soluble urokinase plasminogen activator receptor (suPAR) in COVID-19 patients – a systematic review and meta-analysis

“…Lastly, the suPAR levels between ICU survivors versus nonsurvivors [10,16,26,29] amounted to 5.82±2.33 ng/ml and 8.43±4.66 ng/ml (MD = -3.59; 95%CI: -6.19 to -1.00; p=0.007). On the other hand, in the case of in-hospital mortality, the mean suPAR level among survivors to hospital discharge [15,23,25,29,31] was 5.63±1.27 ng/ml, compared to 7.85±2.61 for patients who did not survive (MD = -3.58; 95%CI: -5.42 to -1.74; p<0.001).…”

“…27 were selected for full text review, as displayed in the flowchart in Figure 2. Finally, 15 studies were included in this meta-analysis [10,[15][16][17][22][23][24][25][26][27][28][29][30][31].…”

“…Of the 14 studies, four were from Greece [26,27,29,30], two from Turkey [18,23], two from Denmark [22,28], two from Italy [16,31], and one in each of the following countries: Sweden [17], China [24], India [25],and Australia [10], and one was an international study [15]. One study was published in 2020 [24], ten in 2021 [10, 16-18, 22, 23, 26-28, 30] and four in 2022 [15,25,29,31]. All included studies had sample sizes ranging from 31 -767 patients.…”

Soluble Urokinase Plasminogen Activator Receptor (suPAR) in the Emergency Department (Ed): A Tool for the Assessment of Elderly Patients

“…In critically ill patients, suPAR levels are associated with increased risk of mortality, hospital admission, readmission rates as well as further complications [ 14 , 20 , 21 , 22 , 23 ]. Furthermore, suPAR values are studied to be strong predictors of mortality when adjusted with NEWS scoring, age and sex in ED patient population, and, interestingly, in hospitalized COVID-19 patients [ 24 , 25 ].…”