title: Plasma levels of soluble urokinase-type plasminogen activator receptor associate with the clinical severity of acute Puumala hantavirus infection.
abstract: OBJECTIVE
  Urokinase-type plasminogen activator receptor is a multifunctional glycoprotein, the expression of which is increased during inflammation. It is known to bind to β3-integrins, which are elementary for the cellular entry of hantaviruses. Plasma soluble form of the receptor (suPAR) levels were evaluated as a predictor of severe Puumala hantavirus (PUUV) infection and as a possible factor involved in the pathogenesis of the disease.
  
  
  METHODS
  A single-centre prospective cohort study.
  
  
  METHODS
  Plasma suPAR levels were measured twice during the acute phase and once during the convalescence in 97 patients with serologically confirmed acute PUUV infection using a commercial enzyme-linked immunosorbent assay (ELISA).
  
  
  RESULTS
  The plasma suPAR levels were significantly higher during the acute phase compared to the control values after the hospitalization (median 8.7 ng/ml, range 4.0-18.2 ng/ml vs. median 4.7 ng/ml, range 2.4-12.2 ng/ml, P<0.001). The maximum suPAR levels correlated with several variables reflecting the severity of the disease. There was a positive correlation with maximum leukocyte count (r = 0.475, p<0.001), maximum plasma creatinine concentration (r = 0.378, p<0.001), change in weight during the hospitalization (r = 0.406, p<0.001) and the length of hospitalization (r = 0.325, p = 0.001), and an inverse correlation with minimum platelet count (r = -0.325, p = 0.001) and minimum hematocrit (r = -0.369, p<0.001).
  
  
  CONCLUSIONS
  Plasma suPAR values are markedly increased during acute PUUV infection and associate with the severity of the disease. The overexpression of suPAR possibly activates β3-integrin in PUUV infection, and thus might be involved in the pathogenesis of the disease.
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Tampere, Finland ; School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Tuula K
authors.initials: TK
authors.lastname: Outinen
authors.forename: Laura
authors.initials: L
authors.lastname: Tervo
authors.forename: Satu
authors.initials: S
authors.lastname: Mäkelä
authors.forename: Reetta
authors.initials: R
authors.lastname: Huttunen
authors.forename: Niina
authors.initials: N
authors.lastname: Mäenpää
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Antti
authors.initials: A
authors.lastname: Vaheri
authors.forename: Jukka
authors.initials: J
authors.lastname: Mustonen
authors.forename: Janne
authors.initials: J
authors.lastname: Aittoniemi
mesh_terms: D000328:Adult; D000368:Aged; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005786:Gene Expression Regulation; D006480:Hemorrhagic Fever with Renal Syndrome / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029262:Puumala virus; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D055815:Young Adult
chemical_list: D055293:Receptors, Urokinase Plasminogen Activator