SuPAR, Biomarkers of Inflammation, and Severe Outcomes in Patients Hospitalized for COVID-19: The International Study of Inflammation in COVID-19: Inflammatory biomarkers and COVID-19 outcomes

• Published in: Journal of medical virology 2024-01, Vol.96 (1), p.e29389-e29389
• Main Authors: Vasbinder, Alexi, Padalia, Kishan, Pizzo, Ian, Machado, Kristen, Catalan, Tonimarie, Presswalla, Feriel, Anderson, Elizabeth, Ismail, Anis, Hutten, Christina, Huang, Yiyuan, Blakely, Pennelope, Azam, Tariq U., Berlin, Hanna, Feroze, Rafey, Launius, Christopher, Meloche, Chelsea, Michaud, Erinleigh, O’Hayer, Patrick, Pan, Michael, Shadid, Husam R., Rasmussen, Line Jee Hartmann, Roberts, Donald A., Zhao, Lili, Banerjee, Mousumi, Murthy, Venkatesh, Loosen, Sven H., Chalkias, Athanasios, Tacke, Frank, Reiser, Jochen, Giamarellos-Bourboulis, Evangelos J., Eugen-Olsen, Jesper, Pop-Busui, Rodica, Hayek, Salim S.
• Format: Article
• Language: English
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.29389

Severe coronavirus disease 2019 (COVID-19) is a hyperinflammatory syndrome. The biomarkers of inflammation best suited to triage patients with COVID-19 are unknown. We conducted a prospective multi-center observational study of adult patients hospitalized specifically for COVID-19 from February 1 st 2020 to October 19 th , 2022. Biomarkers measured included soluble urokinase plasminogen activator receptor (suPAR), C-reactive protein, interleukin-6, procalcitonin, ferritin, and D-dimer. In-hospital outcomes examined include death and need for mechanical ventilation. Patients admitted in the United States (US, n=1,962) were used to compute area under the curves and identify biomarker cut-offs. The combined European cohorts (n=1,137) were used to validate the biomarker cut-offs. In the US cohort, 356 patients met the composite outcome of death (n=197) or need for mechanical ventilation (n=290). SuPAR was the most important predictor of the composite outcome and had the highest area under the curve (0.712) followed by CRP (0.642), ferritin (0.619), IL-6 (0.614), D-dimer (0.606), and lastly procalcitonin (0.596). Inclusion of other biomarkers did not improve discrimination. A suPAR cut-off of 4.0 ng/ml demonstrated a sensitivity of 95.4% (95%CI[92.4%−98.0%]) and negative predictive value of 92.5% (95%CI[87.5%−96.9%]) for the composite outcome. Patients with suPAR