The biomarker suPAR and gastroenterology

• • Cirrhosis^1,2,5
  • Alcoholic liver disease³
  • Excessive alcohol consumption³
  • Nonalcoholic fatty liver disease⁴
  • Acute liver failure^6,8
  • Alcoholic pancreatitis⁷
  • Poor prognosis^1-5,7

In addition, an elevated suPAR level is associated with future incidence of:

• • Hepatocellular carcinoma⁸

Inflammation plays a key role in the development of chronic hepatic diseases. As suPAR is a marker of inflammation, the diagnostic and prognostic value of suPAR in hepatic diseases has been studied.

The suPAR level is significantly higher in patients with cirrhosis compared to healthy controls^1,2. In a study of 159 patients with chronic hepatic diseases, including 98 patients with cirrhosis, the diagnostic ability of suPAR in identifying cirrhosis was good, and suPAR was a strong predictor of mortality or need of transplantation. A cut-off level >9 ng/mL predicted a poor prognosis with a sensitivity and specificity of 70.7% and 77.8%, respectively, as well as a relative risk of 8.5 (3.5-20.3)¹.

The suPAR level is higher in patients with alcoholic aetiology and correlates positively with fibrosis1,3,4. In addition, the suPAR level is higher in individuals with excessive alcohol consumption compared to healthy individuals³.

In patients with decompensated cirrhosis, the suPAR level is significantly higher (median 12.9 ng/mL) than in patients with compensated cirrhosis (8.9 ng/mL), and suPAR is associated with 28-day mortality⁵.

In patients with spontaneous bacterial peritonitis, an elevated suPAR level in ascites fluid was found, and the level was associated with severity and prognosis⁵.

A small study of patients with acute liver failure showed a high median suPAR level of 13.2 ng/mL. Similarly, a strong correlation between suPAR and declining liver function (increasing AST/ALT and INR), independently of the aetiology, was found⁶.

A study of 104 patients shows that the suPAR level on admission was superior to CRP, hematocrit, and creatinine as a prognostic marker of the severity of acute alcoholic pancreatitis. Using a cut-off value of 5 ng/mL, the sensitivity and specificity for predicting moderate or severe pancreatitis were 79% and 78%, respectively. The suPAR level was significantly associated with severity: Mild and moderate/serious: 4.2 ng/mL vs 6.2 ng/mL, respectively⁷.