suPAR can predict mild or severe outcome of a COVID-19 infection

suPAR is an early predictor of severe respiratory failure in patients with COVID-19 pneumonia

At the beginning of the illness, patients may experience low-degree fever or flu-like symptoms.

While some patients have a mild or moderate course of disease, others progress to severe respiratory failure and mechanical ventilation (respirator) is needed to save the patient.

The study asked whether suPAR, measured at admission, can predict which patients will develop severe respiratory failure and which will not.

Photo of virus

Measured suPAR levels from Greek COVID-19 patients by The Hellenic Sepsis Study Group were similar to those collected from patients with COVID-19 from the Emergency Department (ED) of Rush University Medical Center (USA).Patients were followed for 14 days after admission.

The results showed, that admission levels of suPAR were significantly greater among patients who eventually developed severe respiratory failure.

“suPAR can be a strong tool for the much-needed early risk stratification of patients with COVID-19.”

Prof. Ove Andersen, MD, PhD, DmSc, Copenhagen University Hospital Hvidovre, Denmark
suPAR News Vol. 3, June 2020

Patients with suPAR above 6 ng/ml upon admission, had a 16 times higher risk of respiratory failure, than for patients with suPAR below 6 ng/ml.

Conclusion:

The study shows that baseline plasma suPAR level can differentiate whether patients with COVID-19 will have a mild or a severe outcome of the infection.

This can aid in selecting which COVID-19 patients that may be sent home (home quarantine) and which patients that should be admitted to hospital.

See the publication in Critical Care here


suPAR is a marker of chronic inflammation

Patients with high suPAR have a chronically activated immune system, that is not capable of fighting disease.

suPAR is elevated in elderly with comorbidities and capture the most fragile patients. In acute medical patients in general, suPAR is a strong marker of 30-day readmission and mortality1,2.

suPAR has been investigated in several viral infections, including HIV, HCV, Crimean-Congo hemorrhagic fever and hantavirus. In all cases, suPAR is associated with clinical severity and mortality3-6.

Furthermore, patients with respiratory diseases (e.g. pneumonia7 or COPD8) have elevated suPAR and those with the highest level of suPAR have increased 30-day mortality.

It is therefore expected that a virus that causes respiratory distress syndrome will have a more severe impact on patients with elevated suPAR.

A COVID-19 infection is also likely to elevate the suPAR level. In a paper from Wuhan, 15/52 (29%) of patients suffering from severe COVID-19 developed acute kidney injury9, which may be induced by the increase in suPAR10.