Levels of Soluble Urokinase Plasminogen Activator Receptor in Pediatric Lower Respiratory Tract Infections

Abstract

Background: Lower respiratory tract infections (LTRIs) are the most common cause of pediatric emergency department visits and are associated with significant morbidity and mortality. The aim of this study was to evaluate the soluble urokinase plasminogen activator receptor (suPAR) levels in pediatric patients with LRTIs and to investigate the correlation of suPAR with disease severity. Methods: This is a prospective case-control study of children with LTRIs. Demographic data, diagnoses, vital signs, disease severity scores, length of hospital stay, laboratory findings, and viral polymerase chain reaction results for nasopharyngeal aspirates were recorded. Blood samples for suPAR were collected and assessed by enzyme-linked immunosorbent assay. Results: There were 94 patients with LTRIs and 32 children in the control group. Patients were further subdivided into 2 groups based on diagnosis of acute bronchiolitis (n: 31, 33%) or pneumonia (n: 63, 67%). The median levels of suPAR were significantly higher in patients with LTRIs than in healthy controls (4.3 and 3.5 ng/mL, respectively; P = 0.003). There was an association between suPAR levels and disease severity in pneumonia patients. suPAR values were higher in patients with severe pneumonia than mild pneumonia (5.5 and 3.6 ng/mL, respectively; P < 0.001). Conclusion:We have shown that suPAR levels increased in patients with LTRIs and suPAR values were higher in patients with severe pneumonia than mild pneumonia. Further studies with large case series are needed to clarify the role of suPAR levels in children with LTRIs.

Soluble Urokinase Plasminogen Activator Receptor as a Decision Marker for Early Discharge of Patients with COVID-19 Symptoms in the Emergency Department

“… 11 , 12 , 13 , 14 , 15 , 16 Elevated suPAR has also been shown to be associated with increased severity in patients with respiratory diseases, such as pneumonia, chronic obstructive pulmonary disease, and sepsis-related respiratory distress. 17 , 18 , 19 In the general population elevated suPAR is associated with the pace of biological aging, and cognitive decline. [20] Thus, suPAR seems to reflect the individuals health status and capacity to fight disease.…”

suPAR Cut-Offs for Risk Stratification in Patients With Symptoms of COVID-19

“…Secondly, suPAR is associated with clinical severity and/or mortality in several viral infections, including Human Immunodeficiency Virus (HIV) 4 and Hepatitis C, 5 Crimean-Congo hemorrhagic fever, 6 Hantavirus 7 infection, and in patients with SARS-CoV-2 infection. 8 , 9 Thirdly, our target population was patients with symptoms of COVID-19: suPAR is elevated and associated with disease severity in patients with respiratory diseases including pediatric lower respiratory tract pneumonia, 10 chronic obstructive pulmonary disease, 11 - 13 and predicts risk of acute respiratory distress syndrome in patients with sepsis. 14 …”

“…Secondly, suPAR is associated with clinical severity and/or mortality in several viral infections, including Human Immunodeficiency Virus (HIV) 4 and Hepatitis C, 5 Crimean-Congo hemorrhagic fever, 6 Hantavirus 7 infection, and in patients with SARS-CoV-2 infection. 8,9 Thirdly, our target population was patients with symptoms of COVID-19: suPAR is elevated and associated with disease severity in patients with respiratory diseases including pediatric lower respiratory tract pneumonia, 10 chronic obstructive pulmonary disease, [11][12][13] and predicts risk of acute respiratory distress syndrome in patients with sepsis. 14 Elevated suPAR (>6 ng/mL) has been reported to be a strong predictor for need of mechanical ventilation in COVID-19 patients: In a Greek study including 57 patients, positive predictive value (PPV) and negative predictive value (NPV) for prediction of severe respiratory failure defined as need of mechanical ventilation with an admission suPAR >6 ng/mL was 85.7% and 91.7%.…”

Evaluation of Plasma Soluble Urokinase Plasminogen Activator Receptor Levels in Patients With COVID-19 and Non-COVID-19 Pneumonia: An Observational Cohort Study

“…According to a study by Lin et al [11], suPAR values were lower in blood stream infections when caused by viral infections compared to bacterial infections. Moreover, no differences were found between the two groups, in lower respiratory tract infections in a pediatric population and in meningitis [12,13].…”