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      The clinical value of suPAR in diagnosis and prediction for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

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          Abstract

          Background:

          Soluble urokinase-type plasminogen activator receptor (suPAR) is positively correlated with immune system activity. Inflammation can promote the development of chronic obstructive pulmonary disease (COPD). Therefore, this study conducted a systematic review and meta-analysis to assess the association between suPAR levels and the pathogenesis of COPD, and further assess the exact clinical value of suPAR in COPD.

          Methods:

          PubMed, Excerpt Medica Database (Embase), Web of Science (WOS), and Cochrane Library databases were searched for studies that reported the value of suPAR diagnosis for adult COPD patients.

          Results:

          A total of 11 studies were included, involving 4520 participants. Both COPD patients with predicted forced expiratory volume in 1 s (FEV1)⩾80% [weighted mean difference (WMD) = 320.25; 95% confidence interval (CI): 99.79–540.71] and FEV1 < 80% (WMD = 2950.74; 95% CI: 2647.06–3254.43) showed higher suPAR level. The sensitivity and specificity of suPAR for diagnosis of COPD were 87% and 79%, respectively, and AUC was 84%. This can not only effectively identify acute exacerbation of COPD (AECOPD) in a healthy population (WMD = 3114.77; 95% CI: 2814.66–3414.88), but also has the potential to distinguish AECOPD from stable COPD (WMD = 351.40; 95% CI: 215.88–486.93). There was a significant decrease of suPAR level after treatment [WMD = –1226.97; 95% CI: –1380.91– (–1073.03)].

          Conclusion:

          suPAR as a novel biomarker has potential for early diagnosis of COPD and prediction of AECOPD. There is a potential correlation between the level of suPAR and the state of COPD, which may also indicate the early state and severity of COPD. When the suPAR level of COPD patients is further increased, the risk of acute exacerbation increases and should be highly valued. This also shows potential as a measure of treatment response, and as a guide to the clinical management in COPD.

          The reviews of this paper are available via the supplemental material section.

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          Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments

          Carson Lo, Dominik Mertz, Mark Loeb (2014)
          Background Lack of appropriate reporting of methodological details has previously been shown to distort risk of bias assessments in randomized controlled trials. The same might be true for observational studies. The goal of this study was to compare the Newcastle-Ottawa Scale (NOS) assessment for risk of bias between reviewers and authors of cohort studies included in a published systematic review on risk factors for severe outcomes in patients infected with influenza. Methods Cohort studies included in the systematic review and published between 2008–2011 were included. The corresponding or first authors completed a survey covering all NOS items. Results were compared with the NOS assessment applied by reviewers of the systematic review. Inter-rater reliability was calculated using kappa (K) statistics. Results Authors of 65/182 (36%) studies completed the survey. The overall NOS score was significantly higher (p < 0.001) in the reviewers’ assessment (median = 6; interquartile range [IQR] 6–6) compared with those by authors (median = 5, IQR 4–6). Inter-rater reliability by item ranged from slight (K = 0.15, 95% confidence interval [CI] = −0.19, 0.48) to poor (K = −0.06, 95% CI = −0.22, 0.10). Reliability for the overall score was poor (K = −0.004, 95% CI = −0.11, 0.11). Conclusions Differences in assessment and low agreement between reviewers and authors suggest the need to contact authors for information not published in studies when applying the NOS in systematic reviews.
          Article 0 comments Cited 673 times – based on 0 reviews     Review now
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            suPAR: The Molecular Crystal Ball

            Maria Thunø, Betina Macho, Jesper Eugen-Olsen (2009)
            soluble urokinase Plasminogen Activator Receptor (suPAR) levels reflect inflammation and elevated suPAR levels are found in several infectious diseases and cancer. suPAR exists in three forms; suPARI-III, suPARII-III and suPARI which show different properties due to structural differences. Studies suggest that full-length suPAR is a regulator of uPAR/uPA by acting as uPA-scavenger, whereas the cleaved suPARII-III act as a chemotactic agent promoting the immune response via the SRSRY sequence in the linker-region. This review focus on the various suPAR fragments and their involvement in inflammation and pathogenic processes. We focus on the molecular mechanisms of the suPAR fragments and the link to the inflammatory process, as this could lead to medical applications in infectious and pathological conditions.
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              Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review

              Yara Backes, Koenraad van der Sluijs, David P Mackie … (2012)
              Purpose Systemic levels of soluble urokinase-type plasminogen activator receptor (suPAR) positively correlate with the activation level of the immune system. We reviewed the usefulness of systemic levels of suPAR in the care of critically ill patients with sepsis, SIRS, and bacteremia, focusing on its diagnostic and prognostic value. Methods A PubMed search on suPAR was conducted, including manual cross-referencing. The list of papers was narrowed to original studies of critically ill patients. Ten papers on original studies of critically ill patients were identified that report on suPAR in sepsis, SIRS, or bacteremia. Results Systematic levels of suPAR have little diagnostic value in critically ill patients with sepsis, SIRS, or bacteremia. Systemic levels of suPAR, however, have superior prognostic power over other commonly used biological markers in these patients. Mortality prediction by other biological markers or severity-of-disease classification system scores improves when combining them with suPAR. Systemic levels of suPAR correlate positively with markers of organ dysfunction and severity-of-disease classification system scores. Finally, systemic levels of suPAR remain elevated for prolonged periods after admission and only tend to decline after several weeks. Notably, the type of assay used to measure suPAR as well as the age of the patients and underlying disease affect systemic levels of suPAR. Conclusions The diagnostic value of suPAR is low in patients with sepsis. Systemic levels of suPAR have prognostic value, and may add to prognostication of patients with sepsis or SIRS complementing severity-of-disease classification systems and other biological markers.
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                Author and article information

                Contributors
                Qiangru Huang
                Huaiyu Xiong
                Tiankui Shuai
                Yalei Wang
                Chuchu Zhang
                Meng Zhang
                Lei Zhu
                Jiaju Lu
                Jian Liu:
                ORCID: https://orcid.org/0000-0002-1825-571X
                Journal
                Journal ID (nlm-ta): Ther Adv Respir Dis
                Journal ID (iso-abbrev): Ther Adv Respir Dis
                Journal ID (publisher-id): TAR
                Journal ID (hwp): sptar
                Title: Therapeutic Advances in Respiratory Disease
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 1753-4658
                ISSN (Electronic): 1753-4666
                Publication date (Electronic): 9 July 2020
                Publication date Collection: Jan-Dec 2020
                Volume: 14
                Electronic Location Identifier: 1753466620938546
                Affiliations
                [1-1753466620938546]Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
                [2-1753466620938546]The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
                [3-1753466620938546]Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
                [4-1753466620938546]The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
                [5-1753466620938546]Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
                [6-1753466620938546]The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
                [7-1753466620938546]Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
                [8-1753466620938546]The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
                [9-1753466620938546]Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
                [10-1753466620938546]The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
                [11-1753466620938546]Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
                [12-1753466620938546]The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
                [13-1753466620938546]Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
                [14-1753466620938546]The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
                [15-1753466620938546]Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
                [16-1753466620938546]The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
                [17-1753466620938546]Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China
                [18-1753466620938546]The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
                Author notes
                Author information
                https://orcid.org/0000-0002-1825-571X
                Article
                Publisher ID: 10.1177_1753466620938546
                DOI: 10.1177/1753466620938546
                PMC ID: 7350130
                PubMed ID: 32643535
                SO-VID: fd85c4f7-7430-46c6-aa34-a3d2b452ac37
                Copyright © © The Author(s), 2020
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 18 November 2019
                Date accepted : 28 May 2020
                Categories
                Subject: Meta-Analysis
                Custom metadata
                cover-date January-December 2020
                typesetter ts1

                Keywords: biomarker,chronic obstructive pulmonary disease (copd),meta-analysis,systematic review,soluble urokinase-type plasminogen activator receptor (supar)
                Data availability:
                Keywords: biomarker, chronic obstructive pulmonary disease (copd), meta-analysis, systematic review, soluble urokinase-type plasminogen activator receptor (supar)

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