Admission levels of Soluble Urokinase Plasminogen Activator Receptor (suPAR) are Associated with the Development of Severe Complications in Hospitalised COVID-19 Patients: A Prospective Cohort Study

Objective: To examine the association between plasma levels of the soluble urokinase plasminogen activator receptor (suPAR) and the incidence of severe complications of COVID-19. Methods: 403 RT-PCR-confirmed COVID-19 patients were recruited and prospectively followed-up at a major hospital in the United Arab Emirates. The primary endpoint was time from admission until the development of a composite outcome, including acute respiratory distress syndrome (ARDS), intensive care unit (ICU) admission, or death from any cause. Patients discharged alive were considered as competing events to the primary outcome. Competing risk regression was used to quantify the association between suPAR and the incidence of the primary outcome. Results: 6.2% of patients experienced ARDS or ICU admission, but none died. Taking into account competing risk, the incidence of the primary outcome was 11.5% (95% confidence interval [CI], 6.7-16.3) in patients with suPAR levels > 3.91 ng/mL compared to 2.9% (95% CI, 0.4-5.5) in those with suPAR <= 3.91 ng/mL. Also, an increase by 1 ng/mL in baseline suPAR resulted in a 58% rise in the hazard of developing the primary outcome (hazard ratio 1.6, 95% CI, 1.2-2.1, p = 0.003). Conclusion: suPAR has an excellent prognostic utility in predicting severe complications in hospitalised COVID-19 patients. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).

Automated summary

The study demonstrated a significant association between plasma levels of suPAR and the incidence of severe complications in COVID-19 patients, with higher suPAR levels correlating with increased risk of adverse outcomes. For every 1 ng/mL increase in suPAR, there was a 58% rise in the hazard of developing the primary outcome. Therefore, suPAR shows promising prognostic utility in predicting severe complications in hospitalized COVID-19 patients.