Elevated Soluble Urokinase-Type Plasminogen Activator Receptor Levels, Organ Dysfunction, and Death in Children Hospitalized With Malaria: Considerations for Use as a Risk Stratification Tool

Soluble urokinase-type plasminogen activator receptor (suPAR) is an emerging critical illness biomarker. Circulating suPAR levels are elevated in severe malaria and are associated with mortality risk. The present study evaluated clinical predictors of elevated plasma suPAR (≥15 ng/mL). Elevated suPAR occurred in 22.1% of 1226 Ugandan children with severe malaria and was independently associated with severe acute kidney injury, hyperlactatemia, and coma, as well as biomarkers of immune and endothelial activation. An optimized clinical decision algorithm that prioritizes suPAR testing for children with clinical danger signs, including coma and kidney injury, could improve the identification of children at highest risk of death.