The serum level of soluble urokinase receptor is elevated in tuberculosis patients and predicts mortality during treatment: a community study from Guinea-Bissau.
OBJECTIVE
To investigate whether the serum level of soluble urokinase plasminogen activator receptor (suPAR) carries prognostic information in individuals infected with Mycobacterium tuberculosis.


METHODS
suPAR was measured by ELISA in 262 individuals at the time of enrolment into a cohort based on suspicion of active tuberculosis and in 101 individuals after 8 months of follow-up.


RESULTS
The suPAR levels were elevated in patients with active TB compared to TB-negative individuals (P < 0.001). suPAR levels were highest in patients positive for TB on direct microscopy (n = 84, median suPAR 3.17 ng/ml, P < 0.001), followed by patients negative on direct microscopy but culture positive (n = 35, median suPAR 2.41 ng/ml, P = 0.005) and by patients diagnosed on clinical grounds (n = 63, median suPAR 2.13 ng/ml, P = 0.06) compared to 64 TB-negative individuals (median suPAR 1.73 ng/ml). During the 8-month treatment period, 23 TB cases died. In a multivariate Cox model controlling for HIV status, age, sex, CD4 count and type of TB diagnosis, the mortality increase per ng suPAR was 1.25 (95%CI 1.12-1.40). After treatment, suPAR levels had decreased to the levels of TB-negative individuals.


CONCLUSIONS
suPAR levels are elevated in TB patients and associated with mortality. Furthermore, suPAR may be a potential marker of treatment efficacy.
Eugen-Olsen
J
J
Clinical Research Unit, Hvidovre Hospital, Denmark. jeo@biobase.dk
Gustafson
P
P
Sidenius
N
N
Fischer
T K
TK
Parner
J
J
Aaby
P
P
Gomes
V F
VF
Lisse
I
I
D000328:Adult; D015703:Antigens, CD / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D006801:Humans; D008297:Male; D010960:Plasminogen Activators / Q000097:blood*; D016016:Proportional Hazards Models; D011956:Receptors, Cell Surface / Q000097:blood*; D055293:Receptors, Urokinase Plasminogen Activator; D016019:Survival Analysis; D014376:Tuberculosis / Q000097:blood* / Q000401:mortality*
D015703:Antigens, CD; C524898:PLAUR protein, human; D011956:Receptors, Cell Surface; D055293:Receptors, Urokinase Plasminogen Activator; D010960:Plasminogen Activators