NEW STUDY

Circulating suPAR associates with severity and in-hospital progression of COVID-19

BACKGROUND:
COVID-19 disease progression is characterized by hyper inflammation, and risk stratification may aid in early aggressive treatment and advanced planning. The aim of this study was to assess if suPAR and other markers measured at hospital admission can predict the severity of COVID-19.

METHODS:
The primary outcome measure in this international, multi-center, prospective, observational study with adult patients hospitalised primarily for COVID-19 was the association of the World Health Organization Clinical Progression Scale (WHO-CPS) with suPAR ferritin, CRP, albumin, LDH, eGFR, age, procalcitonin, and interleukin-6. Admission plasma suPAR levels were determined using the suPARnostic® ELISA and suPARnostic® Turbilatex assays.

RESULTS:
767 patients, 440 (57.4%) males, and 327 (42.6%) females were included, with mean age of 62 years. Log-suPAR levels were significantly correlated with WHO-CPS score, with every doubling of suPAR increasing the score by one point (p<0.001). All the other markers were also significantly associated with the WHO-CPS score. Admission suPAR levels were significantly lower in survivors (7.10 vs. 9.63, 95% CI 1.47-3.59, p<0.001). A linear model (SALGA) including suPAR, serum albumin, serum lactate dehydrogenase, eGFR, and age can best estimate the WHO-CPS score and survival. Combining all five parameters in the SALGA model can improve the accuracy of discrimination with an AUC of 0.80 (95% CI: 0.759-0.836).

CONCLUSIONS:
suPAR levels were significantly correlated with WHO-CPS score, with every doubling of suPAR increasing the score by one point. The SALGA model may serve as a quick tool at admission for predicting disease severity and survival.