Soluble Urokinase Plasminogen Activator Receptor in Full–Term Neonates with Sepsis: Relation to Disease Severity and Clinical Outcome

Abstract

Background

Urokinase plasminogen activator receptor (uPAR) is a membrane-linked receptor that has extracellular protease activity and is expressed on various cell types. We evaluated soluble uPAR (suPAR) as an early diagnostic and prognostic marker for neonatal sepsis.

Methods

Baseline serum suPAR levels were measured in 70 full-term neonates with proven sepsis on admission and repeated 48 hours after antibiotic therapy. suPAR levels were compared with 35 age- and sex-matched healthy controls.

Results

Baseline suPAR levels were significantly elevated in septic neonates compared with controls (P < .001). Patients with culture-positive sepsis (n = 48) and culture-negative sepsis (n = 22) had higher suPAR compared with controls but no significant difference was found between both septic groups. Baseline suPAR was significantly higher among neonates with septic shock and those who had a worsening disease course or died. suPAR was decreased 48 hours after antibiotic therapy in neonates whose blood cultures turned negative. suPAR cutoff value of 6 ng/mL predicted worsening clinical course with 82.4% sensitivity and 88.9% specificity, while the cutoff value of 7.1 ng/mL predicted mortality with 94.4% sensitivity and 82.4% specificity.

Conclusion

suPAR may be considered an early marker for neonatal sepsis and is a powerful predictor of sepsis severity and mortality among neonates with sepsis.