Evaluating plasma ferritin and soluble urokinase plasminogen activator receptor (suPAR) as treatable traits for critically ill patients with coronavirus disease (COVID-19) treated with anakinra: an exploratory analysis of the immune modulation domain of the REMAP-CAP randomised clinical trial
Authors' conclusion
Plasma ferritin does not identify patients with COVID-19 who benefit from treatment with anakinra, whilst anakinra may be beneficial in patients with low, rather than high, baseline plasma suPAR. These hypothesis-generating findings contrast with the results of clinical trials in non-critically ill patients with COVID-19.
Study context
- Population
- Adults within 24 h of receiving respiratory or cardiovascular organ support in an ICU with suspected or microbiologically confirmed COVID-19included in ferritin analyses, 145 included in the suPAR analyses · ferritin analyses 1,243 · suPAR analyses 145
- Participants
- 1,243 adults
- Comparison
- Anakinra vs control, by baseline plasma ferritin and suPAR
- Primary endpoint
- organ support-free days (OSFD)
- Follow-up
- Until day 21
Methodological detailsBayesian cumulative logistic regression model
- Bayesian cumulative logistic regression model
Primary result
As reported in the abstract
anakinra vs controlOdds ratio (posterior median, anakinra superior; OR > 1 = benefit) (95% CI)
Patients with low baseline suPAR; posterior probability of benefit 94.8%
2.28(0.85–6.06)
Patients with high baseline suPAR; posterior probability of benefit 38.6%
0.88(0.39–2.00)
- Posterior probabilities of anakinra having benefit (OR > 1) across increasing ferritin terciles
- 64%, 71%, and 21%
- Posterior probability of benefit (OR > 1), analyses not adjusted for ferritin levels
- 53%
Further findings
| Outcome | High baseline plasma suPAR (≥ 6 ng/ml) | Low plasma suPAR |
|---|---|---|
| OSFD by baseline plasma suPARNumerically fewer OSFDs with high suPAR | −1.0 (as printed (−1.0, 9.0)) · n = 85 | 13.0 (as printed (−1.0, 17.0)) |
Organ support-free days (OSFD) by ferritin level
- Patients with increasing ferritin levels had numerically fewer OSFDs
Original publication
Evaluating plasma ferritin and suPAR as treatable traits for critically ill patients with COVID-19 treated with anakinra: an exploratory analysis of the immune modulation domain of the REMAP-CAP randomised clinical trial. Crit Care. Published 1 October 2026. doi:10.
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