Abstract
Enhanced level of soluble urokinase plasminogen activator receptor (suPAR) level has been associated with activation of the immune system. It may be a novel biomarker for pneumonia severity, yet data on this subject are limited. In the present study we seek to determine the suPAR level in hospitalized children with community-acquired pneumonia (CAP), its correlation with pneumonia severity, and to compare the suPAR level between pneumonia and healthy conditions. The study encompassed a total of 596 children: 447 with pneumonia and 119 healthy. suPAR was measured in 227 out of the 447 pneumonia patients and in all healthy subjects. We used clinical indicators (fever, time for defeverscence, heart and breath rate, saturation, and length of antibiotic treatment and of hospitalization) and laboratory indicators (CRP, procalcitonin, white blood cell count, and sodium) to assess the CAP severity. The finding were that the suPAR concentration in children with pneumonia was significantly higher (median 7.11 ng/mL) than in healthy individuals (4.68 ng/mL). We found a positive correlation between the suPAR and the following factors: fever, time for defeverscence, length of hospital stay, and elevated CRP and procalcitonin levels. There was a reverse correlation with sodium concentration and capillary blood saturation. Moreover, the suPAR level was significantly higher in children with a severe course of pneumonia compared with those having non-severe pneumonia (7.79 vs. 6.87 ng/mL; p = 0.006). In conclusion, suPAR elevation is observed in pneumonia and may reflect its severity.
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Backes Y, van der Sluijs KF, Mackie DP, Tacke F, Koch A, Tenhunen JJ, Schultz MJ (2012) Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: asystematic review. Intensive Care Med 38:1418–1428
De Witte H, Sweep F, Brunner N, Heuvel J, Beex L, Grebenschikov N, Benraad T (1998) Complexes between urokinase-type plasminogen activator and its receptor in blood as determined by enzyme-linked immunosorbent assay. Int J Cancer 77:236–242
Eugen-Olsen J, Gustafson P, Sidenius N, Fischer TK, Parner J, Aaby P, Gomes VF, Lisse I (2002) The serum level of soluble urokinase receptor is elevated in tuberculosis patients and predicts mortality during treatment: a community study from Guinea-Bissau. Int J Tuberc Lung Dis 6:686–692
Garcia-Monco JC, Coleman JL, Benach JL (2002) Soluble urokinase receptor (uPAR, CD87) is present in serum and cerebrospinal fluid in patients with neurologic diseases. J Neuroimmunol 129:216–223
Gyetko MR, Sud S, Kendall T, Fuller JA, Newstead MW, Standiford TJ (2000) Urokinase receptor-deficient mice have impaired neutrophil recruitment in response to pulmonary Pseudomonas aeruginosa infection. J Immunol 165:1513–1519
Gyetko MR, Aizenberg D, Mayo-Bond L (2004) Urokinase-deficient and urokinase receptor-deficient mice have impaired neutrophil antimicrobial activation in vitro. J Leukoc Biol 76:648–656
Huttunen R, Syrjanen J, Vuento R, Hurme M, Huhtala H, Laine J, Pessi T, Aittoniemi J (2011) Plasma level of soluble urokinase-type plasminogen activator receptor as a predictor of disease severity and case fatality in patients with bacteraemia: a prospective cohort study. J Intern Med 270:32–40
Kofoed K, Eugen-Olsen J, Petersen J, Larsen K, Andersen O (2008) Predicting mortality in patients with systemic inflammatory response syndrome: an evaluation of two prognostic models, two soluble receptors, and a macrophage migration inhibitory factor. Eur J Clin Microbiol Infect Dis 27:375–383
Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE, Child Health Epidemiology Reference Group of WHO, UNICEF (2012) Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379:2151–2161
Madhi SA, De Wals P, Grijalva CG, Grimwood K, Grossman R, Ishiwada N, Lee PI, Nascimento-Carvalho C, Nohynek H, O’Brien KL, Vergison A, Wolter J (2013) The burden of childhood pneumonia in the developed world: a review of the literature. Pediatr Infect Dis J 32:e119–e127
Ostrowski SR, Katzenstein TL, Piironen T, Gerstoft J, Pedersen BK, Ullum H (2004) Soluble urokinase receptor levels in plasma during 5 years of highly active antiretroviral therapy in HIV-1-infected patients. J Acquir Immune Defic Syndr 35:337–342
Ostrowski SR, Piironen T, Hoyer-Hansen G, Gerstoft J, Pedersen BK, Akanmori BD, Kurtzhals JA (2005a) High plasma levels of intact and cleaved soluble urokinase receptor reflect immune activation and are independent predictors of mortality in HIV-1-infected patients. J Acquir Immune Defic Syndr 39:23–31
Ostrowski SR, Ullum H, Goka BQ, Høyer-Hansen G, Obeng-Adjei G, Pedersen BK, Akanmori BD, Kurtzhals JA (2005b) Plasma concentrations of soluble urokinase-type plasminogen activator receptor are increased in patients with malaria and are associated with a poor clinical or a fatal outcome. J Infect Dis 191:1331–1341
Plesner T, Behrendt N, Ploug M (1997) Structure, function and expression on blood and bone marrow cells of the urokinase-type plasminogen activator receptor, uPAR. Stem Cells 15:398–408
Sidenius N, Sier CF, Blasi F (2000a) Shedding and cleavage of the urokinase receptor (uPAR): identification and characterisation of uPAR fragments in vitro and in vivo. FEBS Lett 475:52–56
Sidenius N, Sier CF, Ullum H, Pedersen BK, Lepri AC, Blasi F, Eugen-Olsen J (2000b) Serum level of soluble urokinase-type plasminogen activator receptor is a strong and independent predictor of survival in human immunodeficiency virus infection. Blood 96:4091–4095
Sier CF, Stephens R, Bizik J, Mariani A, Bassan M, Pedersen N, Frigerio L, Ferrari A, Danø K, Brünner N, Blasi F (1998) The level of urokinase-type plasminogen activator receptor is increased in serum of ovarian cancer patients. Cancer Res 58:1843–1849
Stephens RW, Nielsen HJ, Christensen IJ, Thorlacius-Ussing O, Sørensen S, Danø K, Brünner N (1999) Plasma urokinase receptor levels in patients with colorectal cancer: relationship to prognosis. J Natl Cancer Inst 91:869–874
Toldi G, Bekő G, Kádár G, Mácsai E, Kovács L, Vásárhelyi B, Balog A (2013) Soluble urokinase plasminogen activator receptor (suPAR) in the assessment of inflammatory activity of rheumatoid arthritis patients in remission. Clin Chem Lab Med 51:327–332
Wiersinga WJ, Kaqer LM, Hovius JW, ven der Windt GJ, de Vos AF, Meijers JC, Roelofs JJ, Dondorp A, Levi M, Day NP, Peacock SJ, van der Poll T (2010) Urokinase receptor is necessary for bacterial defense against pneumonia-derived septic melioidosis by facilitating phagocytosis. J Immunol 184:3079–3086
Wittenhagen P, Andersen JB, Hansen A, Lindholm L, Ronne F, Theil J, Tvede M, Eugen-Olsen J (2011) Plasma soluble urokinase plasminogen activator receptor in children with urinary tract infection. Biomark Insights 6:79–82
Wrotek A, Pawlik K, Jackowska T (2013) Soluble receptor for urokinase plasminogen activator in community-acquired pneumonia in children. Adv Exp Med Biol 788:329–334
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Supported by the Medical Center of Postgraduate Education in Warsaw grant no. 502-1-20-01-12.
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The authors declare no conflicts of interest in relation to this article.
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Wrotek, A., Jackowska, T., Pawlik, K. (2014). Soluble Urokinase Plasminogen Activator Receptor: An Indicator of Pneumonia Severity in Children. In: Pokorski, M. (eds) Respiratory Infections. Advances in Experimental Medicine and Biology(), vol 835. Springer, Cham. https://doi.org/10.1007/5584_2014_40
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DOI: https://doi.org/10.1007/5584_2014_40
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