Triage suPARcharged

The suPAR biomarker predicts critical illness across diseases, by measuring the level of activation in the immune response.

suPARnostic® is a reliable prognostic tool that enables healthcare professionals to make quick and informed patient triaging decisions at emergency departments in hospitals.

How to interpret suPAR results

“suPAR is relevant to implement in emergency departments since it correlates better to all-cause mortality than the vital-sign based scoring systems.”

Schultz, M., Rasmussen, L.J.H., Kallemose, T. et al. Availability of suPAR in emergency departments may improve risk stratification: a secondary analysis of the TRIAGE III trial. Scand J Trauma Resusc Emerg Med 27, 43 (2019).

Data-based risk evaluation in emergency departments is critical to detect early signs of clinical deterioration and enable timely intervention.

The national early warning score (NEWS) and similar vital sign-based track-and-trigger systems are commonly used in hospital wards to monitor patients’ clinical progress and as a risk assessment of acutely ill patients in the triaging process at the emergency department1, 2.

The use of track-and-trigger systems reduces unexpected in-hospital mortality.3 However, these scores based on clinical signs have limitations in predicting the course of disease, including the case fatality rate.4

In an editorial, Koch & Tacke put forward their theory on how the amount of suPAR in the blood can be utilised as a prognostic, data-based tool to prioritise emergency patients.5

Uusitalo-Seppälä and co-workers conducted a large single-centre prospective study including 539 consecutive patients with suspected infection, in which suPAR was measured at admission to the emergency department.6

The study showed that suPAR levels were strong predictors of 28-day, 90-day, and even 1-year case fatality. It allowed for a better risk stratification than classical inflammatory markers such as procalcitonin and interleukin-6 or C-reactive protein (Fig. 1b).7

Koch and Tacke continue, “A prognostic cut-off value of suPAR concentration could apply to all medical patients in the Emergency department, even those without suspected infection, which would indeed make risk stratification in the Emergency departments suPAR’ easy”.3

The observation was later confirmed in another study of acute medical patients. The study found that suPAR is strongly associated with disease severity, readmission, and mortality after adjusting for all other risk factors. Hence, suPAR adds information to already established prognostic indicators. While patients with low suPAR levels have a low risk of readmission and mortality, patients with high suPAR levels have a high risk of adverse events. 8

suPAR level overview

Figure 1 Koch A. & Tacke F, 2012

  1. Royal College of Physicians: National Early Warning Score (NEWS) – Standardising the assessment of acute-illness severity in the NHS. Report of a working party. 2012
  2. Smith GB, Prytherch DR, Meredith P, et al.: The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation 2013; 84:465–470
  3. Bunkenborg G, Samuelson K, Poulsen I, et al.: Lower incidence of unexpected in-hospital death after interprofessional implementation of a bedside track-and-trigger system. Resuscitation 2014; 85:424–430
  4. 4:Challen K & Goodacre SW.Predictive scoring in non-trauma emergency patients: as coping review. Emerg Med J. 2011;28:827–37.
  5. Koch A. & Tacke F, Editorial Comment: Risk stratification and triage in the emergency department: has this become ‘suPAR’ easy? J Intern Med. 2012, 272; 243–246.
  6. Uusitalo-Seppälä R et al., Soluble urokinase-type plasminogen activator receptor in patients with suspected infection in the emergency room: a prospective cohort study, J Intern Med. 2012 Sep;272(3):247-56.
  7. Eugen-Olsen J. et al. suPAR – a future risk marker, J Intern Med. 2011;270:29–31.
  8. Rasmussen LJ et al, Soluble urokinase plasminogen activator receptor (suPAR) in acute care: a strong marker of disease presence and severity, readmission and mortality. A retrospective cohort study. Emerg Med J. 2016 Nov;33(11):769-775.


published suPAR studies in leading medical journals

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