The Soluble Urokinase Plasminogen Activator Receptor as a Severity Biomarker in Children With Acute COVID-19 or Multisystem Inflammatory Syndrome

BACKGROUND

Elevated soluble urokinase plasminogen activator receptor (suPAR) has been associated with a poor prognosis in serious infections. The aim of this study was to evaluate the clinical value of suPAR in children with acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome (MIS-C).

METHODS

Serum suPAR was measured using the suPARnostic AUTO Flex enzyme-linked immunosorbent assay in hospitalized children with COVID-19, MIS-C, bacterial pneumonia, and healthy controls.

RESULTS

A total of 211 children with a mean (±SD) age of 6.9 ± 4.96 years were tested; with COVID-19: 59 (28%), MIS-C: 36 (17%), pneumonia: 78 (37%) and healthy controls: 38 (18%). In the acute phase, the levels of suPAR (mean ± SD) were: MIS-C: 8.11 ± 2.80 ng/mL, COVID-19: 4.91 ± 1.90 ng/mL, pneumonia: 4.25 ± 1.44 ng/mL and controls: 2.09 ± 0.47 ng/mL ( P < 0.001). Children with acute COVID-19 and a severe or moderate clinical presentation had higher values than those with mild symptoms: 5.79 ± 1.58 versus 5.40 ± 1.94 versus 3.19 ± 0.73 ng/mL, respectively ( P < 0.001). In the MIS-C group, children hospitalized in the intensive care unit and in need of mechanical ventilation had higher suPAR than those who were not admitted to an intensive care unit: 9.32 ± 3.06 versus 7.13 ± 2.19 ng/mL, respectively ( P = 0.023). In children with COVID-19 or MIS-C, a correlation was detected between suPAR values and length of hospitalization ( rs = 0.418, P < 0.001).

CONCLUSIONS

The findings suggest that suPAR may be a valuable biomarker of disease severity in children with COVID-19 or MIS-C. This could facilitate the identification of children in need of intensive anti-inflammatory treatment, as it has been shown in adults with severe COVID-19.

Baylisascaris procyonis roundworm infection patterns in raccoons (Procyon lotor) from Missouri and Arkansas, USA

Baylisascaris procyonis is a helminth parasite of raccoons Procyon lotor and represents a health concern in paratenic hosts, including humans and diverse domestic and wildlife species. In North America the helminth is expanding its geographic range. To better understand patterns of infection in the Ozark region of the USA, raccoons (n = 61) were collected in 2013-2014 from five counties in Missouri and Arkansas, USA and necropsied. We documented B. procyonis in all surveyed locations. The overall prevalence of B. procyonis was 44.3 % (95 % CI = 31.9 - 57.4) and was significantly higher in females than males. There were also significant differences in prevalence among raccoons sampled north and south of the Missouri River. Mean intensity was 9.9 (CI = 5.44 - 17.22), and parasites were highly aggregated among hosts such that approximately 20 % of hosts harbor 90 % of parasites. These levels of parasitism indicate that B. procyonis is common in the region and its impacts on paratenic hosts could be qualitatively similar to effects observed in other localities.