We read with interest the article by Luo et al. [1]. The urokinase-type plasminogen activator system consists of a protease, a receptor urokinase-type plasminogen activator receptor (uPAR), and inhibitors [2]. Depending on the degree of glycosylation and proteolytic cleavage, soluble urokinase-type plasminogen activator receptor (suPAR) is a circulating protein ranging mostly between 20 and 35 kDa [2]. Luo et al. show that suPAR exhibits high accuracy for both diagnosis and prognosis of severe community-acquired pneumonia (CAP) [1]. We would like to make some comments. While the area under the curve (AUC) for suPAR in order to accurately differentiate severe CAP (SCAP) from CAP is extremely good (AUC of 0.835 (p < 0.001) [1], it was reported poor regarding its ability to differentiate severity of sepsis shock (AUC of 0.62) [3]. An explanation could be that nearly half of critically ill patients especially with septic shock have or develop acute kidney injury (AKI) and 20–25% needs renal replacement therapy (RRT) within the first week of their stay [4]. In the study of Luo, only 22 out of the 103 SCPA patients were in septic shock, so the rate of AKI and CRRT was much lower in Luo’s cohort when compared to a full septic shock cohort [4]. Continuous RRT (CRRT) is performed using membranes that have a cut value of 35–40 kDa, and therefore, some quantity of suPAR will be eliminated [5]. New highly adsorptive membranes (HAM) that can adsorb many molecules with a molecular weight above 35 kDa will even increase this removal [5]. This can mislead patient prognostication by artificially decreasing suPAR, but no studies have challenged this issue. Such studies should be done as there is already a long list of biomarkers in sepsis that are lacking reliability during CRRT [5]. To date, no

中文翻译：

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生物标志物 suPAR 似乎是社区获得性肺炎的良好预后因素，但对感染性休克不太突出

我们饶有兴趣地阅读了罗等人的文章。[1]。尿激酶型纤溶酶原激活剂系统由蛋白酶、受体尿激酶型纤溶酶原激活剂受体 (uPAR) 和抑制剂组成 [2]。根据糖基化和蛋白水解切割的程度，可溶性尿激酶型纤溶酶原激活剂受体 (suPAR) 是一种循环蛋白，其分子量主要在 20 到 35 kDa 之间 [2]。罗等人。表明 suPAR 在严重社区获得性肺炎 (CAP) 的诊断和预后方面表现出很高的准确性 [1]。我们想发表一些意见。虽然为了准确区分严重 CAP (SCAP) 和 CAP，suPAR 的曲线下面积 (AUC) 非常好（AUC 为 0.835 (p < 0.001) [1]，但据报道其区分严重性的能力很差）脓毒症休克（AUC 为 0.62）[3]。一种解释可能是，近一半的重症患者，尤其是感染性休克患者，已经或发生了急性肾损伤 (AKI)，20-25% 的患者在住院的第一周内需要肾脏替代治疗 (RRT) [4]。在对罗的研究中，103 名 SCPA 患者中只有 22 名处于感染性休克，因此与完整的感染性休克队列相比，罗的队列中 AKI 和 CRRT 的发生率要低得多 [4]。连续 RRT (CRRT) 使用切割值为 35-40 kDa 的膜进行，因此，将消除一定数量的 suPAR [5]。可以吸附许多分子量超过 35 kDa 的分子的新型高吸附膜 (HAM) 甚至会增加这种去除率 [5]。这可能会通过人为降低 suPAR 来误导患者的预后，但没有研究对这个问题提出质疑。应该进行此类研究，因为在脓毒症中已经有一长串生物标志物在 CRRT 期间缺乏可靠性 [5]。迄今为止，没有