Biomarkers in sepsis-looking for the Holy Grail or chasing a mirage!

Table 7 Soluble urokinase plasminogen activator receptor for prognosis of sepsis

Ref.	Type of study	Patient population	Aim	No. of patients	Results	Conclusion of study
Backes et al[64], 2012	Systematic review	Adults	To assess the usefulness of suPAR levels in critically ill patients with sepsis, SIRS, bacteraemia, focusing (diagnostic and prognostic value)	10 studies	Little diagnostic value in critically ill septic patients. Superior prognostic value in such patients as compared to other markers. Improved mortality prediction by combining suPAR with other markers or disease severity classifications. suPAR levels correlate positively with markers of organ dysfunction and severity of disease classification system scores	suPAR has a low diagnostic value for septic patients. It may add to prognostication with other markers and organ dysfunction scores
Huang et al[18], 2020	Systematic review	Adults	To evaluate the value of suPAR for diagnosis and prognosis of sepsis	30 studies, 6906 patients	Pooled sensitivity and specifity for predicting mortality-0.74 (95%CI: 0.67-0.8) and 0.7 (95%CI: 0.63-0.76) with AUC of 0.78 (95%CI: 0.74-0.82)	suPAR is a good maker for prognostication of sepsis
Pregernig et al[65], 2019	Meta-Analysis	Adults	To assess the prognostic value of suPAR and 6 other biomarkers in predicting mortality in adult septic patients	28 studies included	Pooled mean differences in marker concentrations (survivors-non survivors) at onset of sepsis for suPAR-5.2 ng/mL; 95%CI: 4.5-6; P < 0.01)	suPAR can provide prognostication information about mortality in adult septic patients
Ni et al[66], 2016	Meta-Analysis	Adults	To evaluate the usefulness of suPAR for diagnosis and prognosis of bacterial infections	17 studies included	High suPAR levels were related with a significantly increased risk of death with a pooled risk ratio of 3.37 (95%CI: 2.6-4.38). Pooled sensitivity and specificity for predicting mortality were 0.7 and 0.72 respectively, with AUC of 0.77	suPAR can be used for prognosis of bacterial infection

AUC: Area under the receiver operator characteristic curve; SIRS: Systemic inflammatory response syndrome; suPAR: Soluble urokinase plasminogen activator receptor.