Objective To explore the changes and clinical significance of soluble urokinase plasminogen activator receptor(SuPAR)levels in adults with severe pneumonia.Methods A total of 60 adult patients with pneumonia admitted to Qingyuan People′s Hospital were selected as the research subjects from May 2018 to February 2021.According to the severity of the disease,the patients were divided into group B(patients with common pneumonia,30 cases)and group C(patients with severe pneumonia,30 cases).Meanwhile,thirty healthy individuals were selected as group A.Serum SuPAR levels of the three groups were compared.The pneumonia severity index(PSI)scores of group B and group C were compared.Univariate analysis and multiple linear regression analysis were performed to screen the prognostic factors of patients with severe pneumonia,and the ROC curve was used to analyze the value of serum SuPAR level in predicting severe pneumonia.Results There were significant differences in serum SuPAR levels among the three groups(P＜0.05).The serum SuPAR level of group C was higher than that of group A and B,and the serum Su-PAR level of group B was higher than that of group A,the differences were statistically significant(P＜0.05).The PSI score of group C was higher than that of group B,with statistically significant difference(P＜0.05).The mortality of critically ill patients in 1 month after admission was 20%.Upon admission,the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ),serum SuPAR,procalcitonin(PCT)and receptor of advanced glycation end products(RAGE)were risk factors for severe pneumonia(P＜0.05).The area under the ROC curve of SuPAR for predicting symptomatic pneumonia was 0.932(95%CI=0.866-0.999, P＜0.05).Conclusion Serum SuPAR level is significantly elevated in adults with severe pneumonia,which can be used for severity assessment and prognosis,with certain sensitivity and specificity.It′s clinical value is high.