Intensive Care Medicine

, Volume 39, Issue 3, pp 489–496 | Cite as

SuPAR and PAI-1 in critically ill, mechanically ventilated patients

  • Ville Jalkanen
  • Runkuan Yang
  • Rita Linko
  • Heini Huhtala
  • Marjatta Okkonen
  • Tero Varpula
  • Ville Pettilä
  • Jyrki TenhunenEmail author
  • The FINNALI Study Group



SuPAR (soluble urokinase plasminogen activator receptor) and PAI-1 (plasminogen activator inhibitor 1) are active in the coagulation-fibrinolysis pathway. Both have been suggested as biomarkers for disease severity. We evaluated them in prediction of mortality, acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), sepsis and renal replacement therapy (RRT) in operative and non-operative ventilated patients.


We conducted a prospective, multicenter, observational study. Blood samples and data of intensive care were collected. Mechanically ventilated patients with baseline suPAR and PAI-1 measurements were included in the analysis, and healthy volunteers were analysed for comparison. Receiver operating characteristics (ROC), logistic regression, likelihood ratios and Kaplan–Meier analysis were performed.


Baseline suPAR was 11.6 ng/ml (quartiles Q1–Q3, 9.6–14.0), compared to healthy volunteers with suPAR of 0.6 ng/ml (0.5–11.0). PAI-1 concentrations were 2.67 ng/ml (1.53–4.69) and 0.3 ng/ml (0.3–0.4), respectively. ROC analysis for suPAR 90-day mortality areas under receiver operating characteristic curves (AUC) 0.61 (95 % confidence interval (CI): 0.55–0.67), sepsis 0.68 (0.61–0.76), ALI/ARDS 0.64 (0.56–0.73) and RRT 0.65 (0.56–0.73). Patients with the highest quartile of suPAR concentrations had an odds ratio of 2.52 (1.37–4.64, p = 0.003) for 90-day mortality and 3.16 (1.19–8.41, p = 0.02) for ALI/ARDS. In non-operative patients, the AUC’s for suPAR were 90-day mortality 0.61 (0.54–0.68), RRT 0.73 (0.64–0.83), sepsis 0.70 (0.60–0.80), ALI/ARDS 0.61 (0.51–0.71). Predictive value of PAI-1 was negligible.


In non-operative patients, low concentrations of suPAR were predictive for survival and high concentrations for RRT and mortality. SuPAR may be used for screening for patients with potentially good survival. The association with RRT may supply an early warning sign for acute renal failure.


Plasminogen activator inhibitor 1 (PAI-1) Soluble urokinase plasminogen activator receptor (suPAR) Acute respiratory distress syndrome (ARDS) Acute respiratory failure (ARF) Biomarkers 



This study was supported by external funding for Critical Care Medicine Research Group in Tampere and the Tampere Tuberculosis Foundation. The FINNALI study was supported by EVO-grant from Helsinki University Hospital. We thank all the study nurses and investigators of the FINNALI study.

Conflicts of interest

Dr. Tenhunen was a member of international scientific advisory board for suPARnostic® (travel expenses and lodging) and Chief Medical Officer and shareholder of SenSem Technologies Ltd, Tampere, Finland.

Supplementary material

134_2012_2730_MOESM1_ESM.docx (102 kb)
Supplementary material 1 (DOCX 102 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • Ville Jalkanen
    • 1
  • Runkuan Yang
    • 1
  • Rita Linko
    • 2
  • Heini Huhtala
    • 3
  • Marjatta Okkonen
    • 2
  • Tero Varpula
    • 2
  • Ville Pettilä
    • 2
    • 4
  • Jyrki Tenhunen
    • 1
    • 5
    Email author
  • The FINNALI Study Group
  1. 1.Critical Care Medicine Research Group, Department of Intensive Care MedicineTampere University HospitalTampereFinland
  2. 2.Division of Anaesthesia and Intensive Care Medicine, Department of SurgeryMeilahti Hospital, Helsinki University Central HospitalHelsinkiFinland
  3. 3.School of Health SciencesUniversity of TampereTampereFinland
  4. 4.Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research CentreMonash UniversityMelbourneAustralia
  5. 5.Department of Surgical Sciences, Anaesthesiology and Intensive CareUppsala UniversityUppsalaSweden

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