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Published on: June 8, 2017
Elevated Soluble Urokinase-Type Plasminogen Activator Receptor Levels, Organ Dysfunction, and Death in Children
Charles Ssuuna1, Hridesh Mishra2, Michael T Hawkes3
1CHILD Laboratory, Global Health Uganda, Kampala, Uganda.
Insights
Soluble urokinase-type plasminogen activator receptor (suPAR), a critical illness biomarker, is elevated in severe malaria. Identifying predictors of high suPAR can help pinpoint children at greatest risk of mortality.
Area of Science:
- Biomarkers
- Malaria Research
- Critical Care Medicine
Background:
- Soluble urokinase-type plasminogen activator receptor (suPAR) is an emerging biomarker for critical illnesses.
- Elevated circulating suPAR levels are observed in severe malaria and correlate with mortality risk.
Purpose of the Study:
- To identify clinical predictors associated with elevated plasma suPAR levels (≥15ng/mL) in children with severe malaria.
- To assess the utility of suPAR in identifying high-risk pediatric malaria patients.
Main Methods:
- Analysis of plasma suPAR levels in 1226 Ugandan children diagnosed with severe malaria.
- Evaluation of clinical and laboratory parameters as predictors of elevated suPAR.
Main Results:
- Elevated suPAR was detected in 22.1% of the study cohort.
- High suPAR levels were independently linked to severe acute kidney injury, hyperlactatemia, and coma.
- suPAR elevation also correlated with markers of immune and endothelial activation.
Conclusions:
- Clinical predictors for elevated suPAR in severe malaria include coma and kidney injury.
- An optimized clinical decision algorithm prioritizing suPAR testing in children with danger signs may improve risk stratification.
- suPAR testing can enhance the identification of children with severe malaria at highest risk of mortality.
Abstract:
Soluble urokinase-type plasminogen activator receptor (suPAR) is an emerging critical illness biomarker. Circulating suPAR levels are elevated in severe malaria and are associated with mortality risk. The present study evaluated clinical predictors of elevated plasma suPAR (≥15 ng/mL). Elevated suPAR occurred in 22.1% of 1226 Ugandan children with severe malaria and was independently associated with severe acute kidney injury, hyperlactatemia, and coma, as well as biomarkers of immune and endothelial activation. An optimized clinical decision algorithm that prioritizes suPAR testing for children with clinical danger signs, including coma and kidney injury, could improve the identification of children at highest risk of death.
