The suPAR level is elevated in patients with infections, chronic diseases, and cancer compared to healthy individuals. A high suPAR level is associated with:

  • Increased mortality risk3
  • Poor prognosis5,6,8-10
  • Postoperative pneumonia7
  • Prosthetic joint infection11

suPAR is a well-studied biomarker predicting prognosis, disease severity, and organ dysfunction and is being considered as a marker of the individual’s inflammatory status. It has been demonstrated that biomarkers are able to improve triage and are effective in identifying high and low risk patients among acutely admitted patients1. Improving the preoperative risk stratification using biomarkers may optimize the patient's clinical outcome2. Available data on use of biomarkers in addition to risk stratification are observational data, and suPAR has mainly been studied in medical and oncological patients.

Gastric surgery patients and orthopedic surgery patients were included in a study conducted in the emergency department at Hillerød Hospital, Denmark. The TRIAGE study included 5992 unselected patients and confirmed the prognostic value of suPAR regarding mortality, and found it similar in both medical and surgical patients.

In the same study, it was shown that triage based on suPAR level was superior to the current triage system in predicting 30-day mortality: AUC 0.84 (0.82-0.87) vs. 0.62 (0.58-0.66), respectively. In multivariate analyses of 30-day mortality in relation to suPAR quartiles, adjusted for sex, age, CRP, leucocytes, and triage category, HR was 1.0, 2.2, 8.3, and 26.9 in the upper quartile3.

A high suPAR level has been demonstrated in both tumor tissue and in blood, and in several cancers, the suPAR level is shown to correlate with a poor prognosis4. In a few studies, suPAR has been studied as a potential biomarker in gastric surgery.

In a cohort of 518 elective colorectal cancer patients, preoperative measurement of the suPAR level was performed. In multivariate analyses adjusted for age, sex, tumor classification, and localization, suPAR was significantly associated with mortality, HR 1.74 (1.33-2.26; p<0.0001). In addition, the suPAR level was associated with tumor stage and localization; and in colon cancer patients the suPAR level was significantly higher compared to rectal cancer patients5. The same cohort was also followed in another study, in which the suPAR plasma level was found to be an independent prognostic marker6.

To identify risk patients among elective colon cancer patients the suPAR level was studied. In patients receiving blood transfusion during surgery, the suPAR level was higher, and a significant association between the suPAR level and postoperative infections was shown. Occurrence of pneumonia was significantly associated with the suPAR level, but any significant association with other infectious complications could not be found7.

In patients with gastric cancer, the suPAR level was significantly higher compared to healthy controls (2.3 ng/mL ± 0.77), and the suPAR level was significantly higher in cancer patients with metastatic disease (7.0 ng/mL ± 6.1) than in patients with no metastases (4.8 ng/mL ± 4.4). In the group of patients with a suPAR value above 5.2 ng/mL, the mortality was significantly increased8.

In patients with rectal cancer9 and colon cancer10, a similar prognostic value is found, indicating an increased mortality risk.

suPAR in orthopedic surgery

The diagnostic value of suPAR in prosthetic knee/hip joint infection has been examined in a study. The study included 80 patients of which 45 experienced prosthetic joint infection defined by presence of clinical signs (swelling, redness, tenderness, and pus inside the joint) and a positive culture. In these patients, a significantly higher median suPAR level (6.8 ng/mL) was found compared to patients without infection, who had revision surgery done. Furthermore, suPAR was positively correlated with CRP, and the study showed that suPAR was more precise in diagnosing prosthetic knee/hip joint infection than CRP11.

  1. Schuetz P, Hausfater P, Amin A et al. Biomarkers from distinct biological pathways improve early risk stratification in medical emergency patients: the multinational, prospective, observational TRIAGE study. Critical Care (2015) 19:377
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  3. Østervig RM, Køber L, Forberg JL, Rasmussen LS, Eugen-Olsen J, Iversen K. suPAR—a future prognostic biomarker in emergency medicine. Scand J Trauma Resusc Emerg Med 2015;23(Suppl 1):A31.
  4. Kjellman A, Akre O, Gustafsson O et al. Soluble urokinase plasminogen acitvator receptor as a prognostic marker in men participating in prostate cancer screening. J. intern Med. 2011 Mar;269(3):299-305.
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  7. Svendsen MN, Ytting H, Brünner N et al. Preoperative concentrations of suPAR and MBL proteins are associated with the development of pneumonia after elective surgery for colorectal cancer. Surg Infect (Larchmt) 2006 okt;7(5): 463-471.
  8. Fidan E, Mentese A, Ozedemir F. Diagnostic and prognostic significance of CA IX and suPAR in gastric cancer. Med oncol 2013 jun;30(2):540
  9. Fernebro E, Madsen RR, Fernö M et al. Prognostic importance of the soluble plasminogen activator receptor, suPAR, in plasma from rectal cancer pateints. Eur j cancer 2000; 486-491.
  10. Stephens RW, Nielsen HJ, Christensen IJ. Plasma urokinase recptor levels in patients with colorectal cancer: relationship to prognosis. J natl Cancer Inst 1999, 91, 869-874.
  11. Galliera E, Drago L, Marazzi MG. Soluble urokinase-type plasminogen activator receptor (suPAR) as new biomarker of the prosthetic joint infection: correlation with inflammatory cytokines. Clin Chim Acta 2015 Feb 20;414:23-8.See comment in PubMed Commons below