Circulating soluble urokinase plasminogen activator is elevated in patients with chronic liver disease, discriminates stage and aetiology of cirrhosis and predicts prognosis

Liver Int. 2012 Mar;32(3):500-9. doi: 10.1111/j.1478-3231.2011.02665.x. Epub 2011 Oct 17.


Background: Inflammation is a major factor for the progression of chronic liver diseases. Interactions between urokinase plasminogen activator (uPA) and its receptor (uPAR) have been functionally linked to hepatic inflammation and fibrosis in mice. High serum concentrations of soluble uPAR (suPAR) are suggested to reflect activated immune cells.

Aims: We evaluated suPAR serum levels as a diagnostic and prognostic biomarker in patients with chronic liver diseases.

Methods: Prospective, cross-sectional cohort study of 159 patients with chronic liver diseases (61 without, 98 with established cirrhosis) and 43 healthy controls. Transplant-free survival was monitored for up to 3 years.

Results: Soluble urokinase plasminogen activator serum concentrations were significantly elevated in patients with chronic liver diseases compared with controls. Cirrhotic patients displayed higher levels than non-cirrhotics, closely depending on stage of fibrosis or cirrhosis. suPAR levels had high diagnostic power to identify established cirrhosis in chronic liver diseases. Circulating suPAR closely correlated with liver function, fibrosis markers, but also with systemic inflammation and renal function. A distinct suPAR elevation was noticed in patients with alcoholic aetiology of liver disease. suPAR identified alcoholic origin more precisely compared with classical indicators of alcoholism (mean corpuscular volume, gamma glutamyl transpeptidase). Strikingly, elevated suPAR levels were identified as a strong predictor of mortality or need for transplantation. suPAR levels >9 ng/ml indicated adverse prognosis (sensitivity: 70.7%, specificity: 77.8%, relative risk: 8.5; 95% confidence interval: 3.5-20.3).

Conclusions: Serum suPAR is a potential novel biomarker for the diagnosis of cirrhosis, identification of alcoholic origin and for determining prognosis in patients with chronic liver disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Biomarkers / blood*
  • Case-Control Studies
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Hepatic Insufficiency / blood*
  • Humans
  • Kaplan-Meier Estimate
  • Liver Cirrhosis, Alcoholic / blood*
  • Liver Cirrhosis, Alcoholic / diagnosis*
  • Liver Cirrhosis, Alcoholic / etiology
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • ROC Curve
  • Receptors, Urokinase Plasminogen Activator / blood*
  • Statistics, Nonparametric
  • Urokinase-Type Plasminogen Activator / blood
  • Young Adult


  • Biomarkers
  • Receptors, Urokinase Plasminogen Activator
  • Urokinase-Type Plasminogen Activator