Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review.
OBJECTIVE
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.
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. yarabackes@hotmail.com
Yara
Y
Backes
Koenraad F
KF
van der Sluijs
David P
DP
Mackie
Frank
F
Tacke
Alexander
A
Koch
Jyrki J
JJ
Tenhunen
Marcus J
MJ
Schultz
D015415:Biomarkers; D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D009102:Multiple Organ Failure; D011379:Prognosis; D055293:Receptors, Urokinase Plasminogen Activator / Q000032:analysis*; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000473:pathology*; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000473:pathology
D015415:Biomarkers; D055293:Receptors, Urokinase Plasminogen Activator