NEW STUDY

suPAR as a Prognostic Marker of Ugandan Children at Risk of Severe and Fatal Malaria

Background

Current malaria diagnostic tests do not reliably identify children at risk of severe and fatal infection. Host immune and endothelial activation contribute to malaria pathogenesis. Soluble urokinase-type plasminogen activator receptor (suPAR) is a marker of these pathways. We hypothesized that measuring suPAR at presentation could risk-stratify children with malaria.

Methods

Plasma suPAR levels were determined in consecutive febrile children with malaria at presentation to hospital in Jinja, Uganda. We evaluated the accuracy of suPAR in predicting in-hospital mortality, and whether suPAR could improve a validated clinical scoring system (Lambaréné Organ Dysfunction Score; LODS).

Results
Of the 1226 children with malaria, 39 (3.2%) died. suPAR concentrations at presentation were significantly higher in children who went on to die than in those who survived (P < .0001). suPAR levels were associated with disease severity (LODS 0 v. 1, P = .001; LODS 1 vs. 2, P < .001; LODS 2 vs. 3, LODS 0 vs. 2, LODS 1 vs. 3, and LODS 0 v. 3; P < .0001). suPAR concentrations were excellent predictors of in-hospital mortality (AUROC, 0.92 [95% CI, 0.91-0.94]). The prognostic accuracy of LODS (AUROC, 0.93 [95% CI, 0.91-0.94]) was improved when suPAR was added (AUROC, 0.97 [95% CI, 0.96-0.98]; P < .0001).

Conclusions

Measuring suPAR at presentation can identify children at risk of severe and fatal malaria. Adding suPAR to clinical scores could improve the recognition and triage of children at risk of death. suPAR can be detected with a point-of-care test and can now be evaluated in prospective trials.