Prediction value of soluble urokinase plasminogen activator receptor (suPAR) in COVID-19 patients - a systematic review and meta-analysis

Introduction and Objective. In COVID-19, the rapid prediction of the severity of a patient’s condition using modern biomarkers can accelerate the implementation of appropriate therapy, and thus improve the patient’s prognosis. Materials and method. A meta-analysis was conducted of data available in the literature on the differences in baseline suPAR blood concentration between patients (1) who tested positive and negative for COVID-19, (2) who had severe and non-severe COVID-19, and (3) COVID-19 survivors and non-survivors. Results. SuPAR levels in SARS-CoV-2 negative and positive patients varied and amounted to 3.61±1.59 ng/ml vs. 6.45±3.13 ng/ml, respectively (MD =-3.18; 95%CI:-4.71 to-1.66; p<0.001). suPAR levels among non-severe and severe COVID-19 patients were 5.7 ± 3.0 ng/ml and 7.3 ± 2.7 ng/ml (MD =-1.15; 95%CI:-1.97 to-0.33; p=0.006), respectively. Pooled analysis showed that suPAR levels between severe versus critical COVID-19 patients to be 5.59±1.54 ng/ml and 6.49±1.43 ng/ml, respectively (MD =-1.00; 95%CI:-1.31 to-0.70; p<0.001). The suPAR levels between ICU survivors versus non-survivors [10,16,26,29] amounted to 5.82±2.33 ng/ml and 8.43±4.66 ng/ml (MD =-3.59; 95%CI:-6.19 to-1.00; p=0.007). In the case of in-hospital mortality, the mean suPAR level among survivors to hospital discharge was 5.63±1.27 ng/ml, compared to 7.85±2.61 ng/ml for patients who did not survive (MD =-3.58; 95%CI:-5.42 to-1.74; p<0.001). Conclusions. SuPAR levels are significantly elevated in severe COVID-19 illness and maybe useful in predicting mortality. Further studies are needed to determine cut-off points and clarify the association of suPAR levels with disease progression. This is of utmost importance given the ongoing pandemic and overburdened health care systems.