Evaluation of Plasma Soluble Urokinase Plasminogen Activator Receptor Levels in Patients With COVID-19 and Non-COVID-19 Pneumonia: An Observational Cohort Study

Abstract

Background:The respiratory system is the main system affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and a great number of infected people need hospitalization. Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker indicative of acute and chronic inflammation. Current literature supports that suPAR has great predictive ability for mortality in patients with coronavirus disease 2019 . The aim of this study was to compare the value of suPAR and other laboratory biomarkers in patients with chest infection and suspected COVID-19.Methods: A total of 41 consecutive patients with chest infection were enrolled in the study and were assigned into two groups according to the real-time polymerase chain reaction (PCR) result for SARS-CoV-2. The two groups had no significant difference in baseline data (age, sex), arterial oxygen partial pressure (PO 2 )/fraction of inspired oxygen (FiO 2 ) ratio and mortality.Results: Among patients with chest infection who required hospitalization, suPAR was significantly higher on admission in those with COVID-19 when compared to patients with non-COVID-19. suPAR had a great prognostic ability for in-hospital mortality in the COV-ID-19 subgroup. Conclusions:A single measurement of suPAR on admission can provide prognostic information for patients with suspected COVID-19 pneumonia. In the subgroup of patients with positive real-time PCR result for SARS-CoV2, suPAR was significantly higher and had an excellent prognostic value for the in-hospital mortality.

suPAR: An Inflammatory Mediator for Kidneys

“…suPAR has been shown to be dramatically elevated in patients with severe COVID-19 [ 90 ] and stands out as a predictor of overall disease severity and outcome [ 91 , 92 , 93 , 94 ] including severe respiratory failure [ 95 ] and AKI [ 96 ]. In SARS-CoV-2-infected individuals with low levels of suPAR (<4 ng/mL) upon admission, the risk of needing mechanical ventilation and the 14-day mortality was small, while levels between 4 and 6 ng/mL and especially >6 ng/mL were associated with a significantly increased risk [ 97 ].…”

Soluble Urokinase Plasminogen Activator Receptor (suPAR) Independently Predicts Severity and Length of Hospitalisation in Patients With COVID-19

“…Certain blood-based biomarkers, such as lymphocyte, neutrophil and platelet counts, neutrophil-tomonocyte ratio (NMR), neutrophil-to-lymphocyte ratio (NLR), D-dimer, interleukin-6, C-reactive protein (CRP) levels and lactate dehydrogenase (LDH) may discriminate between severe and non-severe COVID-19 (4,7,8). Another biomarker, the soluble urokinase plasminogen activator receptor (suPAR), has been shown to be significantly elevated in patients with COVID-19 (9), and stands out as a predictor of overall disease severity and outcome (10)(11)(12)(13)(14)(15) and in particular of severe respiratory failure (16), and acute kidney injury (17) due to SARS-CoV-2 infection.…”

Immune system-related soluble mediators and COVID-19: basic mechanisms and clinical perspectives

“…In addition, recently, an increased level of sACE2 in COVID-19 patients and its correlation with the severe form of the disease has been reported [ 95 ]. In contrast to other biomarkers, such as IL-6, CRP, D-dimers, and ferritin, suPAR increases earlier in COVID-19 patients, reflecting a higher risk of disease progression to respiratory failure and respiratory failure mortality [ 91 , 96 , 97 ]. It suggests more attention to patients with a high level of suPAR to identify disease progression early may greatly facilitate the management of COVID-19 patients.…”