Combining a high suPAR level with the qSOFA score 1 can help identify patients who will benefit from early treatment to prevent progression to severe sepsis

suPAR and sepsis

Sepsis, a life-threatening condition triggered by the body’s response to infection, poses a significant medical challenge. Sepsis guidelines suggest immediate start of resuscitation for patients with quick Sequential Organ Failure Assessment (qSOFA) 2 or 3. However, the interpretation of qSOFA 1 remains controversial. Some patients with qSOFA may progress to severe sepsis, but early intervention may prevent this from occurring. However, administering antibiotics to all patients with a qSOFA of 1 would contribute to the increasing level of antimicrobial resistance.

A previous study has shown that a suPAR level of 12 ng/mL or more acts as an independent prediction indicator of death within the patient’s first 28 days of hospitalization (1, 2). In the SUPERIOR trial (3), the goal was to answer the question: Can we use suPAR to identify septic patients in need of early treatment?

The randomized controlled trial included patients over the age of 18 with suspicion of infection, qSOFA=1, and a suPAR blood level of 12 ng/mL or more. Patients were randomized 1:1 to either broad-spectrum antibiotics (meropenem) or placebo. The primary endpoint was early deterioration, defined as at least one-point increase of admission qSOFA score the first 24 hours.

The SUPERIOR trial successfully achieved its primary objective. Measuring suPAR levels in patients admitted to the emergency department with a qSOFA=1 can identify patients in high risk of unfavorable outcomes and guide the decision to provide early treatment. Furthermore, the trial met four other vital endpoints, including preventing a ≥ 2-point increase in admission in the SOFA score occurring within the initial 24 hours, increasing infection resolution, decreasing the time to infection resolution, and providing validation for the prognostic performance of combining qSOFA and suPAR.

suPAR-supported decision making

The figure, shows how suPAR is used to identify patients who can be discharged, patients who should be admitted, and septic patients who will benefit from early treatment with antibiotics.4

Figure 1. The guideline is adapted from (4).

NEW TWO-PAGER: suPAR guided sepsis treatment

Get our two-pager how combining a high suPAR level with the qSOFA score 1 can help identify patients who will benefit from early treatment to prevent progression to severe sepsis

Example of patient cases

Assessment of suPAR and qSOFA supports the decision-making process in the emergency department, minimizing the risk of septic patient deterioration. Sepsis is a leading cause of hospital fatalities, and each minute without diagnosis reduces the survival rates of patients with a sepsis infection.

We have created two patient cases to show how suPAR can be used to guide the treatment of sepsis patients. The two patients are identical except for their suPAR level. These patients’ cases exemplify the critical role of combining suPAR and the qSOFA assessment.

Documented by 1000+ peer-reviewed publications

Here you can find a summary of the research done on suPAR within different disease areas.

1. Giamarellos-Bourboulis EJ, et al. Risk assessment in sepsis: a new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor. Crit Care. 2012 Aug 8;16(4):R149.
2. Eugen-Olsen J, Giamarellos-Bourboulis EJ. suPAR: The unspecific marker for disease presence, severity and prognosis. Int J Antimicrob Agents. 2015 Dec;46 Suppl 1:S33-4.
3. Adami, M.E., (2024) qSOFA combined with suPAR for early risk detection and guidance of antibiotic treatment in the emergency department: a randomized controlled trial. Crit Care 28, 42.
4. Velissaris, D., (2020). Prognostic role of soluble urokinase plasminogen activator receptor at the emergency department: a position paper by the Hellenic sepsis study group. Infectious diseases and therapy, 9, 407-416.


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