Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review

Abstract

Purpose Systemic levels of soluble urokinase-type plasminogen activator receptor (suPAR) positively correlate with the activation level of the immune system. We reviewed the usefulness of systemic levels of suPAR in the care of critically ill patients with sepsis, SIRS, and bacteremia, focusing on its diagnostic and prognostic value. Methods A PubMed search on suPAR was conducted, including manual cross-referencing. The list of papers was narrowed to original studies of critically ill patients. Ten papers on original studies of critically ill patients were identified that report on suPAR in sepsis, SIRS, or bacteremia. Results Systematic levels of suPAR have little diagnostic value in critically ill patients with sepsis, SIRS, or bacteremia. Systemic levels of suPAR, however, have superior prognostic power over other commonly used biological markers in these patients. Mortality prediction by other biological markers or severity-of-disease classification system scores improves when combining them with suPAR. Systemic levels of suPAR correlate positively with markers of organ dysfunction and severity-of-disease classification system scores. Finally, systemic levels of suPAR remain elevated for prolonged periods after admission and only tend to decline after several weeks. Notably, the type of assay used to measure suPAR as well as the age of the patients and underlying disease affect systemic levels of suPAR. Conclusions The diagnostic value of suPAR is low in patients with sepsis. Systemic levels of suPAR have prognostic value, and may add to prognostication of patients with sepsis or SIRS complementing severity-of-disease classification systems and other biological markers.

Procalcitonin and community-acquired pneumonia (CAP) in children

“…Among the biomarkers, PCT and CRP have been carefully studied and compared, leading to controversial results. In addition, other markers for inflammation have been proposed for CAP diagnosis and management, such as the soluble urokinase plasminogen activator receptor (suPAR), however in this case there is still no definitive data [26,27,28]. Overall, the most recent data showed PCT to be the best performance diagnostic marker, especially in terms of detection of a pneumococcal infection [29,30].…”

Soluble Urokinase-type Plasminogen Activator Receptor Predicts All-cause 5-Year Mortality in Ischemic Stroke and TIA

“…infections, various tumors and in cardiovascular diseases (CVD), the membrane-bound uPAR is cleaved from the cell surface and released into the circulation. suPAR has been shown to outperform hsCRP, another marker of inflammation, in the prognosis of several CVDs (13,24,25), but the diagnostic value of suPAR is considered to be low (26,27). New evidence also suggests that suPAR indicates different pathophysiological pathways than hsCRP in atherosclerosis (28).…”

Soluble urokinase plasminogen activator receptor levels are associated with severity of fibrosis in nonalcoholic fatty liver disease

“…12,20 Increased levels of suPAR have been found to predict disease outcome in various forms of cancer and infectious diseases. 21,22 Furthermore, suPAR blood levels correlate with markers of organ dysfunction such as creatinine, urea, cystatin C, bilirubin and albumin in the severely ill. 21 In chronic liver disease with progressive liver fibrosis/cirrhosis, suPAR has also been shown to be elevated and correlate with poor prognosis. [23][24][25] In patients with systemic lupus erythematosus (SLE), suPAR seems to reflect organ damage/disease severity rather than ongoing inflammation.…”