Why high suPAR is not super - diagnostic, prognostic and potential pathogenic properties of a novel biomarker in the ICU

The soluble urokinase plasminogen activator receptor (suPAR) has been suggested as a biomarker that reflects immune cell activation. In critically ill patients, several independent investigations have reported elevated suPAR in conditions of systemic inflammatory response syndrome (SIRS), bacteriemia, sepsis, and septic shock, in which high circulating suPAR levels indicated an unfavorable prognosis. In a prospective cohort study in this issue of Critical Care, suPAR levels were detected in bronchoalveolar lavage (BAL) and identified inhalation injury. High systemic levels indicated an adverse prognosis. This study expands our knowledge of the diagnostic power of suPAR, confirms its prognostic value, and raises the demand for future studies investigating the pathogenic involvement of suPAR.