Circulating suPAR associates with severity and in‐hospital progression of COVID‐19

Abstract

Background COVID‐19 disease progression is characterized by hyperinflammation and risk stratification may aid in early aggressive treatment and advanced planning. The aim of this study was to assess whether suPAR and other markers measured at hospital admission can predict the severity of COVID‐19. Methods The primary outcome measure in this international, multi‐centre, prospective, observational study with adult patients hospitalized primarily for COVID‐19 was the association of WHO Clinical Progression Scale (WHO‐CPS) with suPAR, ferritin, CRP, albumin, LDH, eGFR, age, procalcitonin, and interleukin‐6. Admission plasma suPAR levels were determined using the suPARnostic ® ELISA and suPARnostic ® Turbilatex assays. Results Seven hundred and sixty‐seven patients, 440 (57.4%) males and 327 (42.6%) females, were included with a median age of 64 years. Log‐suPAR levels significantly correlated with WHO‐CPS score, with each doubling of suPAR increasing the score by one point ( p < .001). All the other markers were also correlated with WHO‐CPS score. Admission suPAR levels were significantly lower in survivors (7.10 vs. 9.63, 95% CI 1.47–3.59, p < .001). A linear model (SALGA) including suPAR, serum albumin, serum lactate dehydrogenase, eGFR, and age can best estimate the WHO‐CPS score and survival. Combining all five parameters in the SALGA model can improve the accuracy of discrimination with an AUC of 0.80 (95% CI: 0.759–0.836). Conclusions suPAR levels significantly correlated with WHO‐CPS score, with each doubling of suPAR increasing the score by one point. The SALGA model may serve as a quick tool for predicting disease severity and survival at admission.

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

“…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].…”

“…During the pandemic, the predictive ability of suPAR as a biomarker of illness severity and mortality gained attention. SuPAR levels at admission in patients who survived hospitalization for COVID-19 were lower than in those who died (5.8 ng/mL vs. 8.2 ng/mL, respectively, p<0.001) [15]. SuPAR levels also differed based on disease outcomes: severe cases had significantly higher suPAR levels than mild cases (3.87 ng/mL vs. 2.84 ng/mL, respectively; p=0.01), whereas patients with mild COVID-19 had elevated suPAR levels compared to healthy subjects (2.84 ng/mL vs. 1.68 ng/mL, respectively; p=0.02) [16].…”

Point-of-care prognostication in moderate Covid-19: analytical validation and diagnostic accuracy of a soluble urokinase plasminogen activator receptor (suPAR) rapid test

“…If the tests are adopted for routine use, cut-offs associated with particular clinical management decisions (for example, admission or discharge from the emergency department) or weightings within multivariable triage tools (prediction models) should be assay-dependent. 11,12,22 Similarly, if suPAR measurements are used to inform participant recruitment into clinical trials, it is important that eligibility criteria are tailored to the assay used for enrolment. 23…”

“…9,10 Recently, our group and others developed clinical prediction models incorporating suPAR for both community- and hospital-based triage of patients with Covid-19. 11,12 However, although suPAR is measurable using a commercially-available rapid test, these studies quantified suPAR using laboratory-based immunoassays.…”

Cutting-Edge Approaches in Respiratory and Critical Care Medicine

“…Biomarkers are recognized as essential tools for the diagnosis and management of all the above-mentioned respiratory diseases. It has been previously suggested that suPAR, the soluble form of urokinase plasminogen activator receptor (uPAR), which is a glycosyl-phosphatidylinositol (GPI)-linked membrane protein, can be used as a marker of both inflammation and disease severity [ 21 ]. A recent study that investigated the effectiveness of suPAR as an indicator of the severity of asthma, a chronic inflammatory disease of the airways, demonstrated that suPAR levels could discriminate moderate uncontrolled asthma from severe asthma [ 22 ].…”