Point-of-care prognostication in moderate Covid-19: Analytical validation and prognostic accuracy of a soluble urokinase plasminogen activator receptor (suPAR) rapid test
Issued Date
2023-08-01
Resource Type
eISSN
27673375
Scopus ID
2-s2.0-85195446581
Journal Title
PLOS Global Public Health
Volume
3
Issue
8
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLOS Global Public Health Vol.3 No.8 (2023)
Suggested Citation
Chandna A., Mahajan R., Gautam P., Mwandigha L., Dittrich S., Kumar V., Osborn J., Kumar P., Koshiaris C., Varghese G.M., Lubell Y., Burza S. Point-of-care prognostication in moderate Covid-19: Analytical validation and prognostic accuracy of a soluble urokinase plasminogen activator receptor (suPAR) rapid test. PLOS Global Public Health Vol.3 No.8 (2023). doi:10.1371/journal.pgph.0001538 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98805
Title
Point-of-care prognostication in moderate Covid-19: Analytical validation and prognostic accuracy of a soluble urokinase plasminogen activator receptor (suPAR) rapid test
Author's Affiliation
Angkor Hospital for Children
Mahidol Oxford Tropical Medicine Research Unit
All India Institute of Medical Sciences, Patna
London School of Hygiene & Tropical Medicine
Deggendorf Institute of Technology
Nuffield Department of Medicine
Medecins Sans Frontieres
University of Oxford Medical Sciences Division
Christian Medical College, Vellore
Foundation for Innovative Diagnostics
Mahidol Oxford Tropical Medicine Research Unit
All India Institute of Medical Sciences, Patna
London School of Hygiene & Tropical Medicine
Deggendorf Institute of Technology
Nuffield Department of Medicine
Medecins Sans Frontieres
University of Oxford Medical Sciences Division
Christian Medical College, Vellore
Foundation for Innovative Diagnostics
Corresponding Author(s)
Other Contributor(s)
Abstract
The soluble urokinase plasminogen activator receptor (suPAR) has been proposed as a biomarker for risk stratification of patients presenting with acute infections. However, most studies evaluating suPAR have used platform-based assays, the accuracy of which may differ from point-of-care tests capable of informing timely triage in settings without established laboratory capacity. Using samples and data collected during a prospective cohort study of 425 patients presenting with moderate Covid-19 to two hospitals in India, we evaluated the analytical performance and prognostic accuracy of a commercially-available rapid diagnostic test (RDT) for suPAR, using an enzyme-linked immunosorbent assay (ELISA) as the reference standard. Our hypothesis was that the suPAR RDT might be useful for triage of patients presenting with moderate Covid-19 irrespective of its analytical performance when compared with the reference test. Although agreement between the two tests was limited (bias = -2.46 ng/mL [95% CI = -2.65 to -2.27 ng/mL]), prognostic accuracy to predict supplemental oxygen requirement was comparable, whether suPAR was used alone (area under the receiver operating characteristic curve [AUC] of RDT = 0.73 [95% CI = 0.68 to 0.79] vs. AUC of ELISA = 0.70 [95% CI = 0.63 to 0.76]; p = 0.12) or as part of a published multivariable prediction model (AUC of RDT-based model = 0.74 [95% CI = 0.66 to 0.83] vs. AUC of ELISA-based model = 0.72 [95% CI = 0.64 to 0.81]; p = 0.78). Lack of agreement between the RDT and ELISA in our cohort warrants further investigation and highlights the importance of assessing candidate point-of-care tests to ensure management algorithms reflect the assay that will ultimately be used to inform patient care. Availability of a quantitative point-of-care test for suPAR opens the door to suPAR-guided risk stratification of patients with Covid-19 and other acute infections in settings with limited laboratory capacity.