Hessels Lisa, Duijkers Ruud, Schoorl Marianne, Terpstra Lotte, Thijs Willemien, Boersma Wim
Department of Respiratory Medicine, Northwest Clinics, Alkmaar, the Netherlands.
Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
Clin Respir J. 2025 Jun;19(6):e70089. doi: 10.1111/crj.70089.
Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker elevated in severely ill patients, but its prognostic value in community-acquired pneumonia (CAP) remains unclear. This study aimed to evaluate suPAR's prognostic role for CAP severity compared to other biomarkers and severity scores.
A total of 204 hospitalised CAP patients were enrolled. C-reactive protein (CRP), procalcitonin (PCT), suPAR, CURB-65 and Pneumonia Severity Index (PSI) scores were measured at admission, and patients were followed for 365 days. The primary outcome was the relationship between suPAR levels and CAP severity based on IDSA/ATS guidelines. Secondary outcomes included time to clinical stability (TTCS), length of stay (LOS) and mortality.
Among 204 patients, 174 (85%) had non-severe and 30 (15%) had severe CAP. SuPAR levels were not associated with severe CAP (OR 1.03, 95% CI 0.88-1.21; AUC 0.53). Unlike the PSI and CURB-65 scores, suPAR did not correlate with TTCS (HR PSI 0.80, HR CURB-65 0.86), though all three markers were correlated to LOS (AUC suPAR 0.61). Only suPAR was significantly associated with 30-day mortality (HR 1.51, AUC 0.68).
The prognostic value of suPAR for CAP severity is low, and it does not provide additional prognostic benefit over the CURB-65 or PSI scores in predicting CAP severity. While it has moderate predictive ability for 30-day mortality, its utility for predicting LOS or TTCS is low.
ClinicalTrials.gov identifier: NCT01964495.
可溶性尿激酶型纤溶酶原激活物受体（suPAR）是重症患者中升高的一种生物标志物，但其在社区获得性肺炎（CAP）中的预后价值仍不明确。本研究旨在评估与其他生物标志物和严重程度评分相比，suPAR对CAP严重程度的预后作用。
共纳入204例住院的CAP患者。入院时测量C反应蛋白（CRP）、降钙素原（PCT）、suPAR、CURB-65和肺炎严重程度指数（PSI）评分，并对患者进行365天的随访。主要结局是根据美国感染病学会/美国胸科学会（IDSA/ATS）指南，suPAR水平与CAP严重程度之间的关系。次要结局包括临床稳定时间（TTCS）、住院时间（LOS）和死亡率。
204例患者中，174例（85%）为非重症CAP，30例（15%）为重症CAP。suPAR水平与重症CAP无关（比值比1.03，95%可信区间0.88-1.21；曲线下面积0.53）。与PSI和CURB-65评分不同，suPAR与TTCS无相关性（PSI的风险比0.80，CURB-65的风险比0.86），尽管所有这三种标志物均与LOS相关（suPAR的曲线下面积0.61）。仅suPAR与30天死亡率显著相关（风险比1.51，曲线下面积0.68）。
suPAR对CAP严重程度的预后价值较低，在预测CAP严重程度方面，它没有比CURB-65或PSI评分提供更多的预后益处。虽然它对30天死亡率有中等预测能力，但其预测LOS或TTCS的效用较低。
ClinicalTrials.gov标识符：NCT01964495。
