Serum soluble urokinase-type plasminogen activator receptor as a biological marker of bacterial infection in adults: a systematic review and meta-analysis

Wentao Ni, Yuliang Han, Jin Zhao, Junchang Cui, Kai Wang, Rui Wang, Youning Liu, Wentao Ni, Yuliang Han, Jin Zhao, Junchang Cui, Kai Wang, Rui Wang, Youning Liu

Abstract

The serum concentration of soluble urokinase-type plasminogen activator receptor (suPAR) reflects immune activation. We performed a meta-analysis to evaluate the usefulness of suPAR for the diagnosis and prognosis of bacterial infections. PubMed, Embase and Cochrane Library databases were searched for studies reporting the detection of suPAR in adult patients with bacterial infections. Seventeen studies were selected from 671 studies. The pooled sensitivity and specificity of suPAR for diagnosing infection were 0.73 and 0.79, respectively, and the area under the summary receiver operating characteristic curve (AUC) was 0.82. Subgroup analyses revealed suPAR showed similar AUC values for diagnosing sepsis and bacteremia, but the AUC for differentiating sepsis from systemic inflammatory response syndrome (SIRS) was only 0.68. Elevated suPAR levels were significantly associated with a high risk of death, with a pooled risk ratio of 3.37 (95% confidence interval, 2.60-4.38). The pooled sensitivity and specificity for predicting mortality were 0.70 and 0.72, respectivfely, with an AUC of 0.77. Serum suPAR could be a biomarker for the diagnosis and prognosis of bacterial infection, but it is relatively ineffective for differentiating sepsis from SIRS. Further investigation is required to evaluate whether using of suPAR in combination with other biomarkers can improve diagnostic efficacy.

Figures

Figure 1. Flow chart of study selection.
Figure 1. Flow chart of study selection.
Figure 2. Forrest plot of the sensitivity…
Figure 2. Forrest plot of the sensitivity and specificity of suPAR for the diagnosis of bacterial infections.
Figure 3. Summary receiver operating characteristics curve…
Figure 3. Summary receiver operating characteristics curve for studies evaluating the value of suPAR for the diagnosis of bacterial infections.
SEN, sensitivity; SPE, specificity.
Figure 4. Forest plot of suPAR to…
Figure 4. Forest plot of suPAR to predict mortality in bacterial infections.
RR, risk ratio.
Figure 5. Forrest plot of the sensitivity…
Figure 5. Forrest plot of the sensitivity and specificity of suPAR for the prediction of mortality in bacterial infections.
Figure 6. Summary receiver operating characteristics curve…
Figure 6. Summary receiver operating characteristics curve for studies evaluating the value of suPAR for the prediction of mortality in bacterial infections.
SEN, sensitivity; SPE, specificity.

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