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

Yara Backes, Koenraad F van der Sluijs, David P Mackie, Frank Tacke, Alexander Koch, Jyrki J Tenhunen, Marcus J Schultz, Yara Backes, Koenraad F van der Sluijs, David P Mackie, Frank Tacke, Alexander Koch, Jyrki J Tenhunen, Marcus J Schultz

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.

Figures

Fig. 1
Fig. 1
Systemic levels of suPAR in healthy controls and critically ill patients with SIRS or sepsis, and patients with bacteremia. Systemic levels of suPAR are significantly higher in patients with sepsis, as compared to patient without sepsis or patients with SIRS. Data represent medians with their interquartile range. Extremes were excluded from the figure. Stars indicate the level of statistical difference. Reproduced with permission from [25] and [26]
Fig. 2
Fig. 2
Diagnostic power of suPAR. ROC curve analysis showing the diagnostic power of systemic levels of suPAR in predicting sepsis on admission. AUC, area under the curve. The p value indicates the level of statistical significance. Adapted with permission from [25]
Fig. 3
Fig. 3
Prognostic power of suPAR in ICU patients. Box plot graphics and ROC curve analyses showing the prognostic power of suPAR for mortality on admission, and day 3 and 7 after admission in ICU patients. AUC, area under the curve. The P–value indicates the level of statistical significance. Adapted with permission from [25]
Fig. 4
Fig. 4
Prognostic power of suPAR in patients with sepsis. Box plot graphics and ROC curve analyses showing the prognostic power of suPAR for mortality on admission in patients with sepsis. AUC area under the curve. The p value indicates the level of statistical significance. Adapted with permission from [25]

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