Intensive Care Medicine

, Volume 41, Issue 7, pp 1281–1290 | Cite as

Plasma suPAR as a prognostic biological marker for ICU mortality in ARDS patients

  • Diederik G. P. J. Geboers
  • Friso M. de Beer
  • Anita M. Tuip-de Boer
  • Tom van der Poll
  • Janneke Horn
  • Olaf L. Cremer
  • Marc J. M. Bonten
  • David S. Y. Ong
  • Marcus J. Schultz
  • Lieuwe D. J. Bos



We investigated the prognostic value of plasma soluble urokinase plasminogen activator receptor (suPAR) on day 1 in patients with the acute respiratory distress syndrome (ARDS) for intensive care unit (ICU) mortality and compared it with established disease severity scores on day 1.


suPAR was determined batchwise in plasma obtained within 24 h after admission.


632 ARDS patients were included. Significantly (P = 0.02) higher median levels of suPAR were found with increasing severity of ARDS: 5.9 ng/ml [IQR 3.1–12.8] in mild ARDS (n = 82), 8.4 ng/ml [IQR 4.1–15.0] in moderate ARDS (n = 333), and 9.0 ng/ml [IQR 4.5–16.0] in severe ARDS (n = 217). Non-survivors had higher median levels of suPAR [12.5 ng/ml (IQR 5.1–19.5) vs. 7.4 ng/ml (3.9–13.6), P < 0.001]. The area under the receiver operator characteristic curve (ROC-AUC) for mortality of suPAR (0.62) was lower than the ROC-AUC of the APACHE IV score (0.72, P = 0.007), higher than that of the ARDS definition classification (0.53, P = 0.005), and did not differ from that of the SOFA score (0.68, P = 0.07) and the oxygenation index (OI) (0.58, P = 0.29). Plasma suPAR did not improve the discrimination of the established disease severity scores, but did improve net reclassification of the APACHE score (29 %), SOFA score (23 %), OI (38 %), and Berlin definition classification (39 %).


As a single biological marker, the prognostic value for death of plasma suPAR in ARDS patients is low. Plasma suPAR, however, improves the net reclassification, suggesting a potential role for suPAR in ICU mortality prediction models.


ARDS ICU mortality suPAR Biological marker 



ViroGates A/S, Denmark, donated the ELISA kits for measuring suPAR free of charge. The company had no influence on study design, results, and the decision to publish results. Supported by the Center for Translational Molecular Medicine (, project MARS (grant 04I-201).

Conflicts of interest

MJS serves as an advisor of Virogates A/S, Denmark. He has no financial interests in the company. The authors declare that they have no competing interests.

Supplementary material

134_2015_3924_MOESM1_ESM.pdf (102 kb)
Supplementary material 1 (PDF 101 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Diederik G. P. J. Geboers
    • 1
  • Friso M. de Beer
    • 1
  • Anita M. Tuip-de Boer
    • 3
  • Tom van der Poll
    • 4
  • Janneke Horn
    • 1
  • Olaf L. Cremer
    • 5
  • Marc J. M. Bonten
    • 6
    • 7
  • David S. Y. Ong
    • 5
    • 6
    • 7
  • Marcus J. Schultz
    • 1
  • Lieuwe D. J. Bos
    • 1
    • 2
  1. 1.Department of Intensive CareAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Respiratory MedicineAcademic Medical CenterAmsterdamThe Netherlands
  3. 3.Laboratory of Experimental Intensive Care and Anesthesiology (LEICA)Academic Medical CenterAmsterdamThe Netherlands
  4. 4.Center of Experimental and Molecular Medicine (CEMM)Academic Medical CenterAmsterdamThe Netherlands
  5. 5.Department of Intensive Care MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
  6. 6.Department of Medical MicrobiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  7. 7.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands

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