Severe hemostatic disturbances and impaired fibrinolysis occur in sepsis. In the most serious cases, the dysregulation of fibrinolysis contributes to septic shock, disseminated intravascular coagulation (DIC), and death. Therefore, an analysis of circulating concentrations of pro- and anti-fibrinolytic mediators could be a winning strategy in diagnosing and treating sepsis.

Background: This review summarizes all relevant publications regarding the role of the main components of the plasminogen activation system (PAS) in the pathophysiology of sepsis. In addition, the clinical value of PAS-associated biomarkers in the diagnosis and the outcomes of patients with septic syndrome will be explored. In particular, experimental and clinical trials performed in emergency departments highlight the validity of soluble urokinase plasminogen activator receptor (suPAR) as a predictive and prognostic biomarker in patients with sepsis.

Discussion: A number of proteases including chemotrypsin, trypsin, and uPA itself, can cleave uPAR, thus exposing a chemotactic epitope able to activate chemotaxis receptors of the FPR family on inflammatory cells. Moreover, various types of phospholipases can mediate uPAR release from the cell surface with the release of soluble forms of the receptor, known as suPAR. Serum suPAR is dramatically elevated during sepsis and represents a potential biomarker for predicting its severity better than many other biomarkers, such as CRP and PCT. The study and other studies indicate that serum suPAR levels correlate with different disease severity in COVID-19 patients to support the clinical value of this biomarker as a prognostic index.

Conclusion: According to the scientists, the most interesting marker as a prognostic factor in sepsis is suPAR. Detectable with the ELISA method, suPAR achieves better performance in clinical practice both in predicting mortality and as a guide to therapy.