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Chew-Harris J, Frampton C, Greer C, Appleby S, Pickering JW, Kuan WS, Ibrahim I, Chan SP, Li Z, Liew OW, Adamson PD, Troughton R, Tan LL, Lin W, Ooi SBS, Richards AM, Pemberton CJ. Prognostic performance of soluble urokinase plasminogen activator receptor for heart failure or mortality in Western and Asian patients with acute breathlessness. Int J Cardiol 2024; 406:132071. [PMID: 38643805 DOI: 10.1016/j.ijcard.2024.132071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/28/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
AIMS The performance of circulating soluble urokinase plasminogen activator receptor (suPAR) for predicting the composite endpoint of subsequent heart failure (HF) hospitalisation and/or death at 1 year was assessed in (i) patients with undifferentiated breathlessness, and generalisability was compared in (ii) disparate Western versus Asian sub-cohorts, and in (iii) the sub-cohort adjudicated with HF. METHODS AND RESULTS Patients with acute breathlessness were recruited from the emergency departments in New Zealand (NZ, n = 612) and Singapore (n = 483). suPAR measured in the presentation samples was higher in patients incurring the endpoint (n = 281) compared with survivors (5.2 ng/mL vs 3.1 ng/mL, P < 0.0001). The discriminative power of suPAR for endpoint prediction was c-statistic of 0.77 in the combined population, but was superior in Singapore than NZ (c-statistic: 0.83 vs 0.71, P < 0.0001). Although the highest suPAR tertile (>4.37 ng/mL) was associated with risks of >4-fold in NZ, >20-fold in Singapore, and ≥3-fold in HF for incurring the outcome, there was no interaction between country and suPAR levels after adjustment. Multivariable analysis indicated suPAR to be robust in predicting HF/death at 1-year [hazard ratio: 1.9 (95% CI:1.7 to 2.0) per SD increase] and improved risk discrimination for outcome prediction in HF (∆0.06) and for those with NT-proBNP >1000 pg/mL (∆0.02). CONCLUSION suPAR is a strong independent predictor of HF and/or death at 1 year in acutely breathless patients, in both Asian and Western cohorts, and in HF. suPAR may improve stratification of acutely breathless patients, and in acute HF, for risk of later onset of heart failure or mortality.
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Affiliation(s)
- Janice Chew-Harris
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
| | - Chris Frampton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Charlotte Greer
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Sarah Appleby
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - John W Pickering
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Emergency Care Foundation, Emergency Department, Christchurch Hospital, New Zealand
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Irwani Ibrahim
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siew Pang Chan
- Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Centre for Behavioural and Implementation Science Interventions, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute of Geriatrics & Active Ageing, Tan Tock Seng Hospital, Singapore
| | - Zisheng Li
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Oi Wah Liew
- Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Richard Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Li Ling Tan
- Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Weiqin Lin
- Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shirley Beng Suat Ooi
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiology Department, National University Heart Centre, National University Hospital, Singapore
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Montecillo J, Pirker T, Pemberton C, Chew-Harris J. suPAR in cardiovascular disease. Adv Clin Chem 2024; 121:89-131. [PMID: 38797545 DOI: 10.1016/bs.acc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Soluble urokinase plasminogen activator receptor (suPAR), the soluble counterpart of urokinase plasminogen activator receptor, is found in the circulation at various levels. suPAR and its parent molecule, cell surface uPAR, exhibit similar structure and extracellular functional roles facilitating fibrinolysis, cellular adhesion, and migration. Studies have assessed the correlation between suPAR in cardiovascular disease (CVD). It is postulated that suPAR may serve as an indicator of inflammatory activation and burden during CVD progression. Increased suPAR independently predicts poorer outcomes in acute coronary syndromes, in heart failure, as well as in coronary artery disease and atherosclerosis. To guide translation into clinical utization, suPAR has been assessed in numerous CVD settings for improved risk discrimination independently or in association with established traditional risk factors. Whilst the involvement of suPAR has been explored in other diseases such as kidney diseases and cancer, there is only emerging evidence of suPAR's mechanistic involvement in cardiovascular disease. In this review, we provide a background into suPAR and its potential role as a biomarker in CVD.
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Affiliation(s)
- Jaya Montecillo
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Thomas Pirker
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | | | - Janice Chew-Harris
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
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Ritter A, Lötterle L, Han J, Kalbitz M, Henrich D, Marzi I, Leppik L, Weber B. Evaluation of New Cardiac Damage Biomarkers in Polytrauma: GDF-15, HFABP and uPAR for Predicting Patient Outcomes. J Clin Med 2024; 13:961. [PMID: 38398274 PMCID: PMC10888743 DOI: 10.3390/jcm13040961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Polytrauma is one of the leading mortality factors in younger patients, and in particular, the presence of cardiac damage correlates with a poor prognosis. Currently, troponin T is the gold standard, although troponin is limited as a biomarker. Therefore, there is a need for new biomarkers of cardiac damage early after trauma. Methods: Polytraumatized patients (ISS ≥ 16) were divided into two groups: those with cardiac damage (troponin T > 50 pg/mL, n = 37) and those without cardiac damage (troponin T < 12 pg/mL, n = 32) on admission to the hospital. Patients' plasma was collected in the emergency room 24 h after trauma, and plasma from healthy volunteers (n = 10) was sampled. The plasma was analyzed for the expression of HFABP, GDF-15 and uPAR proteins, as well as miR-21, miR-29, miR-34, miR-122, miR-125b, miR-133, miR-194, miR-204, and miR-155. Results were correlated with patients' outcomes. Results: HFABP, uPAR, and GDF-15 were increased in polytraumatized patients with cardiac damage (p < 0.001) with a need for catecholamines. HFABP was increased in non-survivors. Analysis of systemic miRNA concentrations showed a significant increase in miR-133 (p < 0.01) and miR-21 (p < 0.05) in patients with cardiac damage. Conclusion: All tested plasma proteins, miR-133, and miR-21 were found to reflect the cardiac damage in polytrauma patients. GDF-15 and HFABP were shown to strongly correlate with patients' outcomes.
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Affiliation(s)
- Aileen Ritter
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany; (L.L.); (J.H.); (D.H.); (I.M.); (L.L.); (B.W.)
| | - Lorenz Lötterle
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany; (L.L.); (J.H.); (D.H.); (I.M.); (L.L.); (B.W.)
| | - Jiaoyan Han
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany; (L.L.); (J.H.); (D.H.); (I.M.); (L.L.); (B.W.)
| | - Miriam Kalbitz
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Dirk Henrich
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany; (L.L.); (J.H.); (D.H.); (I.M.); (L.L.); (B.W.)
| | - Ingo Marzi
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany; (L.L.); (J.H.); (D.H.); (I.M.); (L.L.); (B.W.)
| | - Liudmila Leppik
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany; (L.L.); (J.H.); (D.H.); (I.M.); (L.L.); (B.W.)
| | - Birte Weber
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany; (L.L.); (J.H.); (D.H.); (I.M.); (L.L.); (B.W.)
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Matthews T, Rasmussen LJH, Ambler A, Danese A, Eugen-Olsen J, Fancourt D, Fisher HL, Iversen KK, Schultz M, Sugden K, Williams B, Caspi A, Moffitt TE. Social isolation, loneliness, and inflammation: A multi-cohort investigation in early and mid-adulthood. Brain Behav Immun 2024; 115:727-736. [PMID: 37992788 PMCID: PMC11194667 DOI: 10.1016/j.bbi.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/09/2023] [Accepted: 11/19/2023] [Indexed: 11/24/2023] Open
Abstract
Social isolation and loneliness have been associated with poor health and increased risk for mortality, and inflammation might explain this link. We used data from the Danish TRIAGE Study of acutely admitted medical patients (N = 6,144, mean age 60 years), and from two population-representative birth cohorts: the New Zealand Dunedin Longitudinal Study (N = 881, age 45) and the UK Environmental Risk (E-Risk) Longitudinal Twin Study (N = 1448, age 18), to investigate associations of social isolation with three markers of systemic inflammation: C-reactive protein (CRP), interleukin-6 (IL-6), and a newer inflammation marker, soluble urokinase plasminogen activator receptor (suPAR), which is thought to index systemic chronic inflammation. In the TRIAGE Study, socially isolated patients (those living alone) had significantly higher median levels of suPAR (but not CRP or IL-6) compared with patients not living by themselves. Social isolation prospectively measured in childhood was longitudinally associated with higher CRP, IL-6, and suPAR levels in adulthood (at age 45 in the Dunedin Study and age 18 in the E-Risk Study), but only suPAR remained associated after controlling for covariates. Dunedin Study participants who reported loneliness at age 38 or age 45 had elevated suPAR at age 45. In contrast, E-Risk Study participants reporting loneliness at age 18 did not show any elevated markers of inflammation. In conclusion, social isolation was robustly associated with increased inflammation in adulthood, both in medical patients and in the general population. It was associated in particular with systemic chronic inflammation, evident from the consistently stronger associations with suPAR than other inflammation biomarkers.
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Affiliation(s)
- Timothy Matthews
- School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom.
| | - Line Jee Hartmann Rasmussen
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA; Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Antony Ambler
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; National and Specialist CAMHS Trauma and Anxiety Clinic, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; ViroGates A/S, Birkerød, Denmark
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, United Kingdom
| | - Helen L Fisher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom
| | - Kasper Karmark Iversen
- Department of Emergency Medicine, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Schultz
- Department of Emergency Medicine, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Karen Sugden
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Benjamin Williams
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Terrie E Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Guduguntla BA, Vasbinder A, Anderson E, Azam TU, Blakely P, Webster NJ, Gonzalez R, Atonucci T, Heidebrink JL, Giordani B, Zahodne L, Hampstead BM, Ajrouch KJ, Hayek SS. Biomarkers of chronic inflammation and cognitive decline: A prospective observational study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12568. [PMID: 38532827 PMCID: PMC10964918 DOI: 10.1002/dad2.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
We sought to determine whether the biomarkers of chronic inflammation predict cognitive decline in a prospective observational study. We measured baseline serum soluble urokinase plasminogen activator receptor (suPAR) and high sensitivity C-reactive protein (hs-CRP) levels in 282 participants of the University of Michigan Memory and Aging Project. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and the Clinical Dementia Rating (CDR) scale for up to five time points. SuPAR and hs-CRP levels were not significantly higher in participants with mild cognitive impairment (n = 97) or dementia (n = 59), compared to those with normal cognitive function (n = 126). Overall, 14% of participants experienced significant cognitive decline over the study period. The change in MoCA or CDR scores over time did not differ significantly according to baseline suPAR or hs-CRP levels. Chronic systemic inflammation, as measured by serum suPAR or hs-CRP levels, is unlikely to contribute significantly to cognitive decline.
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Affiliation(s)
| | - Alexi Vasbinder
- Division of CardiologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Elizabeth Anderson
- Division of CardiologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Tariq U. Azam
- Division of CardiologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Pennelope Blakely
- Division of CardiologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Noah J. Webster
- Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
| | - Richard Gonzalez
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Toni Atonucci
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | | | - Bruno Giordani
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
- Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
| | - Laura Zahodne
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Benjamin M. Hampstead
- Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
- Mental Health Service Line, Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Kristine J. Ajrouch
- Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
- Eastern Michigan UniversityYpsilantiMichiganUSA
| | - Salim S. Hayek
- Division of CardiologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
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Vasbinder A, Padalia K, Pizzo I, Machado K, Catalan T, Presswalla F, Anderson E, Ismail A, Hutten C, Huang Y, Blakely P, Azam TU, Berlin H, Feroze R, Launius C, Meloche C, Michaud E, O'Hayer P, Pan M, Shadid HR, Rasmussen LJH, Roberts DA, Zhao L, Banerjee M, Murthy V, Loosen SH, Chalkias A, Tacke F, Reiser J, Giamarellos-Bourboulis EJ, Eugen-Olsen J, Pop-Busui R, Hayek SS. SuPAR, biomarkers of inflammation, and severe outcomes in patients hospitalized for COVID-19: The International Study of Inflammation in COVID-19. J Med Virol 2024; 96:e29389. [PMID: 38235904 PMCID: PMC10829525 DOI: 10.1002/jmv.29389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024]
Abstract
Severe coronavirus disease 2019 (COVID-19) is a hyperinflammatory syndrome. The biomarkers of inflammation best suited to triage patients with COVID-19 are unknown. We conducted a prospective multicenter observational study of adult patients hospitalized specifically for COVID-19 from February 1, 2020 to October 19, 2022. Biomarkers measured included soluble urokinase plasminogen activator receptor (suPAR), C-reactive protein, interleukin-6, procalcitonin, ferritin, and D-dimer. In-hospital outcomes examined include death and the need for mechanical ventilation. Patients admitted in the United States (US, n = 1962) were used to compute area under the curves (AUCs) and identify biomarker cutoffs. The combined European cohorts (n = 1137) were used to validate the biomarker cutoffs. In the US cohort, 356 patients met the composite outcome of death (n = 197) or need for mechanical ventilation (n = 290). SuPAR was the most important predictor of the composite outcome and had the highest AUC (0.712) followed by CRP (0.642), ferritin (0.619), IL-6 (0.614), D-dimer (0.606), and lastly procalcitonin (0.596). Inclusion of other biomarkers did not improve discrimination. A suPAR cutoff of 4.0 ng/mL demonstrated a sensitivity of 95.4% (95% CI: 92.4%-98.0%) and negative predictive value (NPV) of 92.5% (95% CI: 87.5%-96.9%) for the composite outcome. Patients with suPAR < 4.0 ng/mL comprised 10.6% of the cohort and had a 0.8% probability of the composite outcome. Applying this cutoff to the validation cohort yielded a sensitivity of 93.8% (90.4%-96.7%) and NPV of 95.5% (93.1%-97.8%) for the composite outcome. Among commonly measured biomarkers, suPAR offered stronger discriminatory ability and may be useful in triaging low-risk patients with COVID-19.
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Affiliation(s)
- Alexi Vasbinder
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kishan Padalia
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ian Pizzo
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristen Machado
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tonimarie Catalan
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Feriel Presswalla
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Anderson
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anis Ismail
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christina Hutten
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yiyuan Huang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Pennelope Blakely
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tariq U Azam
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Hanna Berlin
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rafey Feroze
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher Launius
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Chelsea Meloche
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Erinleigh Michaud
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick O'Hayer
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Pan
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Husam R Shadid
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Donald A Roberts
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lili Zhao
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Mousumi Banerjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Venkatesh Murthy
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Rodica Pop-Busui
- Division of Endocrinology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Salim S Hayek
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Ismail A, Hayek SS. Role of Soluble Urokinase-Type Plasminogen Activator Receptor in Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1797-1810. [PMID: 37948017 DOI: 10.1007/s11886-023-01991-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE OF REVIEW Chronic inflammation is a major contributor to cardiovascular disease (CVD) risk. Soluble urokinase plasminogen activator receptor (suPAR) is an immune-derived glycoprotein that is strongly associated with atherosclerotic disease. This review summarizes evidence on suPAR's role in CVD pathogenesis and its potential as a prognostic indicator and therapeutic target. RECENT FINDINGS Clinical, genetic, and experimental evidence supports suPAR's role as a pathogenic factor in atherosclerosis. suPAR promotes atherosclerosis through modulation of monocyte activation and function. Clinically, elevated suPAR levels are linked to increased cardiovascular risk across diverse populations. Ongoing clinical trials are evaluating therapies targeting suPAR signaling. Current evidence positions suPAR as a regulator of myeloid cell function that contributes to vascular inflammation and subsequent cardiovascular events. Additional research is needed to determine whether suPAR measurement can improve CVD risk prediction and enable personalized management. Overall, suPAR is a promising immune-derived biomarker and target for reducing inflammation and cardiovascular risk.
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Affiliation(s)
- Anis Ismail
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, CVC #2709, Ann Arbor, 48109, MI, USA
| | - Salim S Hayek
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, CVC #2709, Ann Arbor, 48109, MI, USA.
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Hayek SS, Tahhan AS, Ko YA, Alkhoder A, Zheng S, Bhimani R, Hartsfield J, Kim J, Wilson P, Shaw L, Wei C, Reiser J, Quyyumi AA. Soluble Urokinase Plasminogen Activator Receptor Levels and Outcomes in Patients with Heart Failure. J Card Fail 2023; 29:158-167. [PMID: 36122818 PMCID: PMC10246488 DOI: 10.1016/j.cardfail.2022.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Soluble urokinase-type plasminogen activator receptor (suPAR) is a marker of immune activation and pathogenic factor for kidney disease shown to predict cardiovascular outcomes including heart failure (HF) in various populations. We characterized suPAR levels in patients with HF and compared its ability to discriminate risk to that of B-type natriuretic peptide (BNP). METHODS AND RESULTS We measured plasma suPAR and BNP levels in 3,437 patients undergoing coronary angiogram and followed for a median of 6.2 years. We performed survival analyses for the following outcomes: all-cause death, cardiovascular death, and hospitalization for HF. We then assessed suPAR's ability to discriminate risk for the aforementioned outcomes. We identified 1116 patients with HF (age 65±12, 67.2% male, 20.0% Black, 67% with reduced ejection fraction). The median suPAR level was higher in HF compared to those without HF (3370 [IQR 2610-4371] vs. 2880 [IQR 2270-3670] pg/mL, respectively, P<0.001). In patients with HF, suPAR levels (log-base 2) were associated with outcomes including all-cause death (adjusted hazard ratio aHR 2.30, 95%CI[1.90-2.77]), cardiovascular death (aHR 2.33 95%CI[1.81-2.99]) and HF hospitalization (aHR 1.96, 95%CI[1.06-1.25]) independently of clinical characteristics and BNP levels. The association persisted across subgroups and did not differ between patients with reduced or preserved ejection fraction, or those with ischemic or non-ischemic cardiomyopathy. Addition of suPAR to a model including BNP levels significantly improved the C-statistic for death (Δ0.027), cardiovascular death (Δ0.017) and hospitalization for HF (Δ0.017). CONCLUSIONS SuPAR levels are higher in HF compared to non-HF, are strongly predictive of outcomes, and combined with BNP, significantly improved risk prediction. LAY SUMMARY
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Affiliation(s)
- Salim S Hayek
- Division of Cardiology, University of Michigan, Ann Arbor, MI.
| | | | - Yi-An Ko
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Ayman Alkhoder
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Shuai Zheng
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Ravila Bhimani
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Joy Hartsfield
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Jonathan Kim
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Peter Wilson
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Leslee Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Changli Wei
- Department of Medicine, Rush University, Chicago, IL
| | - Jochen Reiser
- Department of Medicine, Rush University, Chicago, IL
| | - Arshed A Quyyumi
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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9
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Kapoor PM, Prakash M, Mujahid OM. suPAR as a risk Prediction Biomarker in Extracorporeal Membrane Oxygenation. JOURNAL OF CARDIAC CRITICAL CARE TSS 2023. [DOI: 10.25259/jccc_5_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
suPAR is a promising biomarker of cardiovascular diseases, as it reflects “low-grade inflammation” and is associated with lifestyle factors such as smoking, alcohol, and an inactive lifestyle. suPAR is expressed in various cells involved in the development of atherosclerosis, including macrophages, endothelial cells, and smooth muscle cells, and an accumulation of suPAR in the atheroma has also been found. suPAR plays a role in the coagulation cascade during plasminogen activation and fibrinolysis. This abstract provides description of three case series showing the utility of suPAR as a risk prediction biomarker on VA extracorporeal membrane oxygenation (ECMO). We used SUPAR in 15 patients undergoing cardiac surgery of which three went on VA ECMO. Herein, we describe in detail three such patients and discuss each with good review of the literature.
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Affiliation(s)
| | - Mohit Prakash
- Department of Cardiac Anesthesia and Critical Care, AIIMS, New Delhi, India,
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10
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Self-rated health and chronic inflammation are related and independently associated with hospitalization and long-term mortality in the general population. Sci Rep 2022; 12:19761. [PMID: 36396700 PMCID: PMC9670062 DOI: 10.1038/s41598-022-24422-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
The subjective indicator of health self-rated health (SRH) and the chronic inflammation biomarker soluble urokinase plasminogen activator receptor (suPAR) are both robust predictors of healthcare use and mortality. However, the possible relationship between SRH and suPAR in the assessment of hospitalization and mortality risk is unknown. We used data from the Danish population-based Inter99 cohort to examine the association between SRH and suPAR and test their individual and combined associations with 2-year risk of acute hospitalization and 5- and 15-year mortality. SRH and serum suPAR levels were measured in 5490 participants (median age 45.1 years, 48.7% men). Poorer SRH was associated with elevated suPAR. In unadjusted analyses, SRH and suPAR were individually associated with higher risks of acute hospitalization and mortality, and both measures remained independently associated with higher risks of hospitalization and 15-year mortality after mutual adjustments. The association of suPAR with mortality was stronger in poorer SRH categories, and when combined, SRH and suPAR could identify different groups of individuals with increased risk of acute hospitalization and mortality. Both SRH and suPAR were independently associated with risk of acute hospitalization and mortality, and different combinations of the two measures could identify different groups of individuals at increased risk.
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11
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Hongisto M, Lassus J, Tarvasmäki T, Sans-Roselló J, Tolppanen H, Kataja A, Jäntti T, Sabell T, Banaszewski M, Silva-Cardoso J, Parissis J, Jurkko R, Spinar J, Castrén M, Mebazaa A, Masip J, Harjola VP. Soluble urokinase-type plasminogen activator receptor improves early risk stratification in cardiogenic shock. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:731–738. [PMID: 35949144 PMCID: PMC9629697 DOI: 10.1093/ehjacc/zuac096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
AIMS Soluble urokinase-type plasminogen activator receptor (suPAR) is a biomarker reflecting the level of immune activation. It has been shown to have prognostic value in acute coronary syndrome and heart failure as well as in critical illness. Considering the complex pathophysiology of cardiogenic shock (CS), we hypothesized suPAR might have prognostic properties in CS as well. The aim of this study was to assess the kinetics and prognostic utility of suPAR in CS. METHODS AND RESULTS SuPAR levels were determined in serial plasma samples (0-96 h) from 161 CS patients in the prospective, observational, multicentre CardShock study. Kinetics of suPAR, its association with 90-day mortality, and additional value in risk-stratification were investigated. The median suPAR-level at baseline was 4.4 [interquartile range (IQR) 3.2-6.6)] ng/mL. SuPAR levels above median were associated with underlying comorbidities, biomarkers reflecting renal and cardiac dysfunction, and higher 90-day mortality (49% vs. 31%; P = 0.02). Serial measurements showed that survivors had significantly lower suPAR levels at all time points compared with nonsurvivors. For risk stratification, suPAR at 12 h (suPAR12h) with a cut-off of 4.4 ng/mL was strongly associated with mortality independently of established risk factors in CS: OR 5.6 (95% CI 2.0-15.5); P = 0.001) for death by 90 days. Adding suPAR12h > 4.4 ng/mL to the CardShock risk score improved discrimination identifying high-risk patients originally categorized in the intermediate-risk category. CONCLUSION SuPAR associates with mortality and improves risk stratification independently of other previously known risk factors in CS patients.
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Affiliation(s)
- Mari Hongisto
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Johan Lassus
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Tuukka Tarvasmäki
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Jordi Sans-Roselló
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Biomedical Research Institute IIB-Sant Pau, CIBER-CV, Spain
| | - Heli Tolppanen
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Anu Kataja
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Toni Jäntti
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Tuija Sabell
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | | | - Jose Silva-Cardoso
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, São João University Medical Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - John Parissis
- ER and Heart Failure Unit, Attikon University Hospital, National and Kapodestrian University of Athens, Athens, Greece
| | - Raija Jurkko
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Jindrich Spinar
- St. Ann university hospital and Medical faculty Masaryk University, Brno, Czech Republic
| | - Maaret Castrén
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | | | - Josep Masip
- Research Direction, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
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12
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Omran F, Kyrou I, Osman F, Lim VG, Randeva HS, Chatha K. Cardiovascular Biomarkers: Lessons of the Past and Prospects for the Future. Int J Mol Sci 2022; 23:ijms23105680. [PMID: 35628490 PMCID: PMC9143441 DOI: 10.3390/ijms23105680] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a major healthcare burden on the population worldwide. Early detection of this disease is important in prevention and treatment to minimise morbidity and mortality. Biomarkers are a critical tool to either diagnose, screen, or provide prognostic information for pathological conditions. This review discusses the historical cardiac biomarkers used to detect these conditions, discussing their application and their limitations. Identification of new biomarkers have since replaced these and are now in use in routine clinical practice, but still do not detect all disease. Future cardiac biomarkers are showing promise in early studies, but further studies are required to show their value in improving detection of CVD above the current biomarkers. Additionally, the analytical platforms that would allow them to be adopted in healthcare are yet to be established. There is also the need to identify whether these biomarkers can be used for diagnostic, prognostic, or screening purposes, which will impact their implementation in routine clinical practice.
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Affiliation(s)
- Farah Omran
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Ioannis Kyrou
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5FB, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece
| | - Faizel Osman
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Ven Gee Lim
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Harpal Singh Randeva
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Kamaljit Chatha
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (F.O.); (I.K.); (F.O.); (V.G.L.); (H.S.R.)
- Biochemistry and Immunology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Correspondence:
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13
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Walter JE, Amrein MLF, Schäfer I, Zimmermann T, Lopez-Ayala P, Boeddinghaus J, Twerenbold R, Puelacher C, Nestelberger T, Wussler D, Honegger U, Badertscher P, Eugen-Olsen J, Koechlin L, Fahrni G, Jeger R, Kaiser C, Zellweger M, Mueller C. Soluble urokinase plasminogen activator receptor and functionally relevant coronary artery disease: a prospective cohort study. Biomarkers 2022; 27:278-285. [PMID: 35112976 DOI: 10.1080/1354750x.2022.2038269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Soluble urokinase plasminogen activator receptor (suPAR) is an emerging biomarker associated with anatomical CAD burden and cardiovascular outcomes including myocardial infarction (MI) and death. We aimed at validating previous findings of the prognostic value of suPAR and evaluated its diagnostic potential for functional relevant CAD (fCAD). METHODS Consecutive patients with suspected fCAD were enrolled. Adjudication of fCAD was performed blinded to suPAR concentrations by myocardial perfusion single photon emission tomography (MPI-SPECT) and coronary angiography. Prognostic outcome measures included all-cause, cardiovascular death, and incident MI during 2-year follow-up. RESULTS Among consecutive 968 patients, SuPAR concentrations were higher in patients with fCAD compared to those without (3.45ng/mL versus 3.20ng/mL, p = 0.007), without acceptable diagnostic accuracy (area under the curve [AUC]: 0.56, 95%CI 0.52-0.60). SuPAR correlated with high-sensitivity cardiac-troponin (hs-cTn) T (Spearman's rho (ρ) 0.393, p < 0.001), NT-proBNP (ρ = 0.327, p < 0.001), age (ρ = 0.364, p < 0.001) and very weakly with coronary atherosclerosis (ρ = 0.123, p < 0.001). Prognostic discrimination of suPAR was moderate for cardiovascular death (AUC =0.72, 95%CI 0.62-0.81) and all-cause death (AUC =0.72, 95%CI 0.65-0.79) at 2-years. SuPAR remained a significant predictor for all-cause death in the full model (HR =1.96, p = 0.001). CONCLUSIONS SuPAR was an independent predictor of all-cause death, without diagnostic utility for fCAD.
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Affiliation(s)
- Joan Elias Walter
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.,Department of Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Melissa Lee Fen Amrein
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Ibrahim Schäfer
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Tobias Zimmermann
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.,University Heart & Vascular Center Hamburg, Germany
| | - Christian Puelacher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.,Department of Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.,Vancouver General Hospital, University of British Columbia, Canada
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.,Universitäts-Herzzentrum Bad Krozingen, Germany
| | - Ursina Honegger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Denmark
| | - Luca Koechlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.,Department of Cardiac Surgery, University Hospital Basel, University of Basel, Switzerland
| | - Gregor Fahrni
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Raban Jeger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Christoph Kaiser
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Michael Zellweger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
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14
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Rasmussen LJH, Petersen JEV, Eugen-Olsen J. Soluble Urokinase Plasminogen Activator Receptor (suPAR) as a Biomarker of Systemic Chronic Inflammation. Front Immunol 2021; 12:780641. [PMID: 34925360 PMCID: PMC8674945 DOI: 10.3389/fimmu.2021.780641] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/09/2021] [Indexed: 01/08/2023] Open
Abstract
Systemic chronic inflammation (SCI) is persistent, health-damaging, low-grade inflammation that plays a major role in immunosenescence and in development and progression of many diseases. But currently, there are no recognized standard biomarkers to assess SCI levels alone, and SCI is typically measured by combining biomarkers of acute inflammation and infection, e.g., CRP, IL-6, and TNFα. In this review, we highlight 10 properties and characteristics that are shared by the blood protein soluble urokinase plasminogen activator receptor (suPAR) and SCI, supporting the argument that suPAR is a biomarker of SCI: (1) Expression and release of suPAR is upregulated by immune activation; (2) uPAR and suPAR exert pro-inflammatory functions; (3) suPAR is associated with the amount of circulating immune cells; (4) Blood suPAR levels correlate with the levels of established inflammatory biomarkers; (5) suPAR is minimally affected by acute changes and short-term influences, in contrast to many currently used markers of systemic inflammation; (6) Like SCI, suPAR is non-specifically associated with multiple diseases; (7) suPAR and SCI both predict morbidity and mortality; (8) suPAR and SCI share the same risk factors; (9) suPAR is associated with risk factors and outcomes of inflammation above and beyond other inflammatory biomarkers; (10) The suPAR level can be reduced by anti-inflammatory interventions and treatment of disease. Assessing SCI has the potential to inform risk for morbidity and mortality. Blood suPAR is a newer biomarker which may, in fact, be a biomarker of SCI since it is stably associated with inflammation and immune activation; shares the same risk factors as many age-related diseases; is both elevated by and predicts age-related diseases. There is strong evidence that suPAR is a prognostic marker of adverse events, morbidity, and mortality. It is associated with immune activity and prognosis across diverse conditions, including kidney disease, cardiovascular disease, cancer, diabetes, and inflammatory disorders. Thus, we think it likely represents a common underlying disease-process shared by many diseases; that is, SCI. We review the supporting literature and propose a research agenda that can help test the hypothesis that suPAR indexes SCI, with the potential of becoming the new gold standard for measuring SCI.
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Affiliation(s)
- Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Jens Emil Vang Petersen
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, United States
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
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15
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Dardashti A, Sterner N, Fisher J, Thelaus L, Nilsson J, Linder A, Zindovic I. Impact of cardiopulmonary bypass and surgical complexity on plasma soluble urokinase-type plasminogen activator receptor levels after cardiac surgery. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:634-640. [PMID: 34657538 DOI: 10.1080/00365513.2021.1990395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Circulating soluble urokinase plasminogen activator receptor (suPAR) is a marker of inflammation with prognostic value for elevated risk of morbidity and mortality. It has not yet been shown how the inflammatory process induced by cardiac surgery affects suPAR concentrations postoperatively. METHODS In a prospective observational study, plasma suPAR levels were measured in 30 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), pre-, peri, post-operatively, and 3-5 days after surgery. Fifteen patients underwent coronary artery bypass grafting (CABG) and 15 underwent complex procedures with longer CPB duration. Concentrations of suPAR at each time point were compared to the preoperative levels and compared between the two groups. RESULTS In both groups, plasma suPAR concentrations were significantly higher on the first postoperative day (3.27 (interquartile range (IQR) 2.75-3.86) µg/L compared to baseline (2.62 (1.98-3.86)) µg/L, p < .001. There were no significant differences in suPAR concentrations between the groups at any time point. Preoperatively, the median suPAR concentration was 2.57 (2.01-3.60) µg/L in the CABG group versus 2.67 (1.89-3.97) µg/L in the complex group (p = .567). At ICU arrival 2.48 (2.34-3.23) µg/L versus 2.73 (2.28-3.44) µg/L in CABG and complex patients, respectively (p = .914). There was no difference in suPAR concentrations between the groups on postoperative day 1 (3.34 (2.89-3.89) versus 3.19 (2.57-3.62) p = .967) or 3-5 days after surgery (2.72 (1.98-3.16) versus 2.96 (2.39-4.28) p = .085. CONCLUSIONS After a transient rise on the first postoperative day, the suPAR levels returned to the preoperative levels by the third postoperative day. There was no significant difference in suPAR levels between the routine CABG and complex group with longer CPB time.
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Affiliation(s)
- Alain Dardashti
- Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Niklas Sterner
- Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Jane Fisher
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Faculty of Medicine, Lund, Sweden
| | - Louise Thelaus
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Faculty of Medicine, Lund, Sweden
| | - Johan Nilsson
- Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Adam Linder
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Faculty of Medicine, Lund, Sweden
| | - Igor Zindovic
- Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
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16
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Rasmussen LJH, Caspi A, Ambler A, Danese A, Elliott M, Eugen-Olsen J, Hariri AR, Harrington H, Houts R, Poulton R, Ramrakha S, Sugden K, Williams B, Moffitt TE. Association Between Elevated suPAR, a New Biomarker of Inflammation, and Accelerated Aging. J Gerontol A Biol Sci Med Sci 2021; 76:318-327. [PMID: 32766674 PMCID: PMC7812430 DOI: 10.1093/gerona/glaa178] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background To understand and measure the association between chronic inflammation, aging, and age-related diseases, broadly applicable standard biomarkers of systemic chronic inflammation are needed. We tested whether elevated blood levels of the emerging chronic inflammation marker soluble urokinase plasminogen activator receptor (suPAR) were associated with accelerated aging, lower functional capacity, and cognitive decline. Methods We used data from the Dunedin Study, a population-representative 1972–1973 New Zealand birth cohort (n = 1037) that has observed participants to age 45 years. Plasma suPAR levels were analyzed at ages 38 and 45 years. We performed regression analyses adjusted for sex, smoking, C-reactive protein, and current health conditions. Results Of 997 still-living participants, 875 (88%) had plasma suPAR measured at age 45. Elevated suPAR was associated with accelerated pace of biological aging across multiple organ systems, older facial appearance, and with structural signs of older brain age. Moreover, participants with higher suPAR levels had greater decline in physical function and cognitive function from childhood to adulthood compared to those with lower suPAR levels. Finally, improvements in health habits between ages 38 and 45 (smoking cessation or increased physical activity) were associated with less steep increases in suPAR levels over those years. Conclusions Our findings provide initial support for the utility of suPAR in studying the role of chronic inflammation in accelerated aging and functional decline.
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Affiliation(s)
- Line Jee Hartmann Rasmussen
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.,Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.,Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Antony Ambler
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Andrea Danese
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.,National and Specialist Child and Adolescent Mental Health Services Trauma, Anxiety, and Depression Clinic, South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Maxwell Elliott
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Ahmad R Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - HonaLee Harrington
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Renate Houts
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Richie Poulton
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Karen Sugden
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Benjamin Williams
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Terrie E Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.,Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
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17
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Bengaard AK, Iversen E, Kallemose T, Juul-Larsen HG, Rasmussen LJH, Dalhoff KP, Andersen O, Eugen-Olsen J, Houlind MB. Using soluble urokinase plasminogen activator receptor to stratify patients for medication review in the emergency department. Br J Clin Pharmacol 2021; 88:1679-1690. [PMID: 34242432 DOI: 10.1111/bcp.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS To investigate whether the association between levels of medication use (including polypharmacy and potentially inappropriate medications [PIMs]) and health outcomes such as readmission and mortality is dependent on baseline soluble urokinase plasminogen activator receptor (suPAR). METHODS This registry-based cohort study included medical patients admitted to the emergency department at Copenhagen University Hospital Hvidovre, Denmark. Patients were grouped according to their admission suPAR levels: low (0-3 ng/mL), intermediate (3-6 ng/mL), or high (>6 ng/mL). Hyper-polypharmacy was defined as ≥10 prescribed medications. PIMs were identified based on the EU(7)-PIM list, and data on admissions and mortality were obtained from national registries. Risk of 90-day readmission and mortality was assessed by Cox regression analysis adjusted for sex, age and Charlson comorbidity index. Results were reported as hazard ratios within 90 days of index discharge. RESULTS In total, 26 291 patients (median age 57.3 y; 52.7% female) were included. Risk of 90-day readmission and mortality increased significantly for patients with higher suPAR or higher number of medications. Among patients with low suPAR, patients with ≥10 prescribed medications had a hazard ratio of 2.41 (95% confidence interval = 2.09-2.78) for 90-day readmission and 8.46 (95% confidence interval = 2.53-28.28) for 90-day mortality compared to patients with 0 medications. Patients with high suPAR generally had high risk of readmission and mortality, and the impact of medication use was less pronounced in this group. Similar, but weaker, association patterns were observed between suPAR and PIMs. CONCLUSION The association between levels of medication use and health outcomes is dependent on baseline suPAR.
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Affiliation(s)
- Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Kim Peder Dalhoff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Emergency Department, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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18
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Rasmussen SR, Nielsen RV, Møgelvang R, Ostrowski SR, Ravn HB. Prognostic value of suPAR and hsCRP on acute kidney injury after cardiac surgery. BMC Nephrol 2021; 22:120. [PMID: 33827466 PMCID: PMC8025450 DOI: 10.1186/s12882-021-02322-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Acute kidney injury (AKI) represents a serious complication following cardiac surgery. Adverse outcome after cardiac surgery has been observed in the presence of elevated levels of soluble urokinase-type plasminogen activator receptor (suPAR) and high-sensitivity C-Reactive Protein (hsCRP). The aim of study was (i) to investigate the relationship between preoperative elevated levels of suPAR and hsCRP and postoperative AKI in unselected cardiac surgery patients and (ii) to assess whether the concentration of the biomarkers reflected severity of AKI. Methods In a retrospective observational study, biobank blood plasma samples (n = 924) from patients admitted for elective on-pump cardiac surgery were analysed for suPAR and hsCRP levels. The relation between suPAR and hsCRP-values and AKI (any stage), defined by the KDIGO (Kidney Disease: Improving Global Outcomes) criteria, was assessed using adjusted logistic regression. Further, the association between biomarkers and severity (KDIGO 1, KDIGO 2–3 and renal replacement therapy (RRT)) was assessed using adjusted logistic regression. Results Postoperative AKI (any stage) was observed in 327 patients (35.4 %). A doubling of preoperative suPAR corresponded to an adjusted odds ratio (OR) for postoperative AKI (any stage) of 1.62 (95 % CI 1.26–2.09, p < 0.001). Furthermore, a doubling of suPAR had an adjusted OR of 1.50 (95 % CI 1.16–1.93, p = 0.002), 2.44 (95 % CI 1.56–3.82, p < 0.001) and 1.92 (95 % CI 1.15–3.23, p = 0.002), for KDIGO 1, KDIGO 2–3 and need for RRT, respectively. No significant association was found between elevated levels of hsCRP and any degree of AKI. Conclusions Increasing levels of suPAR, but not hsCRP, were associated with development and severity of AKI following on-pump cardiac surgery.
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Affiliation(s)
- Sebastian Roed Rasmussen
- Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Rikke Vibeke Nielsen
- Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Clinical Cardiovascular Research Unit, University of Southern Denmark, Svendborg, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Anaesthesiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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19
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Huet F, Dupuy AM, Duflos C, Reis CA, Kuster N, Aguilhon S, Cristol JP, Roubille F. Soluble urokinase-type plasminogen activator receptor strongly predicts global mortality in acute heart failure patients: insight from the STADE-HF registry. Future Sci OA 2021; 7:FSO697. [PMID: 34046195 PMCID: PMC8147742 DOI: 10.2144/fsoa-2020-0197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Whether soluble urokinase-type plasminogen activator receptor (suPAR) could be a valuable prognostic indicator remains uncertain. Materials & methods Patients from STADE-HF (Soluble Suppression of Tumorigenesis-2 as a Help for Management of Diagnosis, Evaluation and Management of Heart Failure) were included for analysis. Results 95 patients were included. The suPAR level of expression was significantly higher in the group of patients who died at one month (7.90 ± 4.35 ng/ml vs 11.94 ± 6.86 ng/ml; p < 0.05) or 1 year (7.28 ± 4.27 ng/ml vs 11.81 ± 4.88 ng/ml; p < 0.01), but there was no significant difference according to the readmission. Conclusion High suPAR levels during hospitalization for acute heart failure were highly predictive for the risk of mortality, but not the risk of readmission.
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Affiliation(s)
- Fabien Huet
- Cardiology Department, University Hospital of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR, 9214, Montpellier, 34090, France
| | - Anne-Marie Dupuy
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, 34090, France
| | - Claire Duflos
- Medico-Economic Research Unit, CHU Montpellier, University of Montpellier, Montpellier, 34090, France
| | - Cintia Azara Reis
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Nils Kuster
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR, 9214, Montpellier, 34090, France.,Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, 34090, France
| | - Sylvain Aguilhon
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR, 9214, Montpellier, 34090, France
| | - François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR, 9214, Montpellier, 34090, France
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20
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Velissaris D, Zareifopoulos N, Koniari I, Karamouzos V, Bousis D, Gerakaris A, Platanaki C, Kounis N. Soluble Urokinase Plasminogen Activator Receptor as a Diagnostic and Prognostic Biomarker in Cardiac Disease. J Clin Med Res 2021; 13:133-142. [PMID: 33854652 PMCID: PMC8016523 DOI: 10.14740/jocmr4459] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 12/26/2022] Open
Abstract
This review summarizes the published literature referring to the use and validity of the biomarker soluble urokinase plasminogen activator receptor (suPAR) when used for the assessment of patients with cardiac diseases. It is measured by enzyme-linked immunosorbent assay (ELISA) in plasma samples. In cardiology a cut-off value range of 3.5 - 4.5 ng/mL has been commonly utilized. Different cut-off values may be applied based on the measuring kit used, the patient population and the clinical setting. A PubMed/Medline search was conducted aiming to identify all publications relevant to the use of suPAR in patients with cardiac diseases. A total of 39 studies were included in this review. suPAR as a marker of inflammation has been used more extensively in recent years, alone or in combination with other biomarkers of inflammation and cardiac pathology in the assessment of patients with acute and chronic cardiac diseases. suPAR is closely related to the pathophysiology of cardiac disease, and a number of publications encourages its use as a valuable biomarker in the assessment of patients presenting to the cardiology service. It may be most valuable in the risk assessment of patients with acute coronary syndromes and congestive heart failure, as suPAR elevation may be an independent predictor of mortality in these conditions. In conclusion, among several biomarkers used for clinical entities with underlying inflammatory pathophysiology including cardiac diseases, suPAR is a novel attractive index for the prognostic risk stratification of cardiac patients. More research is warranted to confirm its diagnostic and prognostic validity, alone or combined with other cardiac and inflammatory biomarkers.
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Affiliation(s)
- Dimitrios Velissaris
- Department of Internal and Emergency Medicine, University of Patras, Patras, Greece
| | | | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | | | - Dimitris Bousis
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Andreas Gerakaris
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Christina Platanaki
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Nicholas Kounis
- Department of Cardiology, University of Patras, Patras, Greece
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21
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Does Soluble Urokinase-Type Plasminogen Activator Receptor Level Predicts the Occurrence of Inflammatory Complications in Maxillofacial Surgery? APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Soluble urokinase-type plasminogen activator receptor (suPAR) is a marker of immune activation and reflects a more distinct aspect of inflammation than C-reactive protein (CRP) does. The study concerns a clinically silent state of the immune system expressed by the level of suPAR, which could affect the occurrence of complications (non-life threatening) after scheduled procedures. The purpose was the evaluation of suPAR predictive value in minor maxillofacial surgery complication incidents. Eighty patients were tested for suPAR, CRP and a series of basic laboratory serum tests on 1 day before surgery. Complications of orthognathic and minor injuries treatments were reported. The suPAR level, expressed as a measure independent of the patient’s age (Index of Body Inflammation, IBI), was analyzed. The protein level was also assessed on postoperative day 3. Basic statistical analysis did not reveal any relevant dependence between suPAR (or IBI) and occurrence of minor complications. The application of factor analysis, artificial neural network and inclusion of chlorides, glycaemia, alanine transaminase (ALT), albumin and hemoglobin levels allowed to indicate the suPAR/IBI ranges associated with an increased risk of minor postoperative complications. Concluding, it seems that, in the current state of the knowledge, the monitoring of pre-operational suPAR level solely does not include sufficient predictive information for the occurrence of minor complications after maxillofacial surgery. The suPAR/IBI level should be combined with other patient characteristics to predict healing complications.
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22
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Prognostic value of soluble urokinase plasminogen activator receptor in patients presenting to the emergency department with chest pain suggestive of acute coronary syndrome. Clin Biochem 2021; 92:19-24. [PMID: 33662350 DOI: 10.1016/j.clinbiochem.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/20/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Soluble urokinase plasminogen activator receptor (suPAR) is a prognostic biomarker of cardiovascular disease. OBJECTIVES We aimed to evaluate the early prognostic value of suPAR in patients presenting to the emergency department (ED) with chest pain suggestive of acute coronary syndrome (ACS). PATIENTS AND METHODS In a post-hoc analysis from a multicenter study including patients with a chest pain < 6 h, suPAR concentrations at ED admission were studied according to the outcome at 30-days. RESULTS 198 patients (median age 56 years) in whom 16% had an ACS, were included. Fifteen (7.3%) patients presented a 30-day event. At ED admission, median (IQR) suPAR concentrations were higher in patients with a 30-day event in comparison to patients without event (4.54 (3.09-8.61) vs. 2.72 (2.10-3.43) ng/mL, p < 0.001). The ROC curve AUC of suPAR for the prediction of a 30-days event was 0.775 [95%CI: 0.710-0.831]. The optimal threshold was 3.3 ng/mL, with a sensitivity of 73 [45-92] % and a specificity of 72 [65-79] %. The association of a suPAR < 3.3 ng/mL AND a NT-proBNP < 160 ng/L AND a HEART score < 4 had a negative predictive value of 99 [91-100] %. A suPAR value at admission above 3.3 ng/mL was independently and significantly associated with a 30-day event in chest pain emergency patients (OR 4.87 [1.35-17.51], p = 0.015). CONCLUSION suPAR is a promising biomarker for early prediction of events in chest pain emergency patients.
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23
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Jhee JH, Nam BY, Lee CJ, Park JT, Han SH, Kang SW, Park S, Yoo TH. Soluble Urokinase-Type Plasminogen Activator Receptor, Changes of 24-Hour Blood Pressure, and Progression of Chronic Kidney Disease. J Am Heart Assoc 2020; 10:e017225. [PMID: 33325248 PMCID: PMC7955457 DOI: 10.1161/jaha.120.017225] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Soluble urokinase‐type plasminogen activator receptor (suPAR) is associated with cardiovascular risks and poor renal outcomes. However, whether elevated suPAR levels are associated with 24‐hour blood pressure patterns or kidney disease progression in patients with chronic kidney disease (CKD) is unclear. Methods and Results A total of 751 patients with CKD stage 1 to 5 were recruited from CMERC‐HI (Cardiovascular and Metabolic Disease Etiology Research Center–High Risk) cohort study (2013–2018). The relationship of serum suPAR levels to 24‐hour blood pressure parameters and CKD progression was analyzed. The median serum suPAR level was 1439.0 (interquartile range, 1026.2–2150.1) pg/mL, and the mean estimated glomerular filtration rate was 52.8±28.5 mL/min per 1.73 m2 at baseline. Patients with higher suPAR levels had significantly higher levels of office, 24‐hour, daytime, and nighttime systolic blood pressure and nighttime diastolic blood pressure than those with lower suPAR levels. The highest suPAR tertile was associated with an increased risk of a reverse dipping pattern (odds ratio, 2.93; 95% CI, 1.27–6.76; P=0.01). During a follow‐up of 43.2 (interquartile range, 27.0–55.6) months, the CKD progression occurred in 271 (36.1%) patients. The highest suPAR tertile was significantly associated with higher risk of CKD progression than the lowest tertile (hazard ratio [HR], 2.09; 95% CI, 1.37–3.21; P=0.001). When the relationship was reevaluated with respect to each dipping pattern (dipper, extreme dipper, nondipper, and reverse dipper), this association was consistent only in reverse dippers in whom the risk of CKD progression increased (HR, 1.43; 95% CI, 1.02–2.01; P=0.03) with every 1‐unit increase in serum suPAR levels. Conclusions Elevated suPAR levels are independently associated with CKD progression, and this association is prominent in reverse dippers.
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Affiliation(s)
- Jong Hyun Jhee
- Division of Nephrology Department of Internal Medicine Gangnam Severance HospitalYonsei University College of Medicine Seoul Korea
| | - Bo Young Nam
- Department of Internal Medicine College of Medicine Severance Biomedical Science Institute Brain Korea 21 PLUS Yonsei University Seoul Korea
| | - Chan Joo Lee
- Division of Cardiology Severance Cardiovascular Hospital and Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular Diseases Yonsei University College of Medicine Seoul Korea
| | - Jung Tak Park
- Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea
| | - Seung Hyeok Han
- Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea
| | - Shin-Wook Kang
- Department of Internal Medicine College of Medicine Severance Biomedical Science Institute Brain Korea 21 PLUS Yonsei University Seoul Korea.,Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea
| | - Sungha Park
- Division of Cardiology Severance Cardiovascular Hospital and Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular Diseases Yonsei University College of Medicine Seoul Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea
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Krychtiuk KA, Speidl WS, Giannitsis E, Gigante B, Gorog DA, Jaffe AS, Mair J, Möckel M, Mueller C, Storey RF, Vilahur G, Wojta J, Huber K, Halvorsen S, Geisler T, Morais J, Lindahl B, Thygesen K. Biomarkers of coagulation and fibrinolysis in acute myocardial infarction: a joint position paper of the Association for Acute CardioVascular Care and the European Society of Cardiology Working Group on Thrombosis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 10:343-355. [PMID: 33620437 DOI: 10.1093/ehjacc/zuaa025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
The formation of a thrombus in an epicardial artery may result in an acute myocardial infarction (AMI). Despite major advances in acute treatment using network approaches to allocate patients to timely reperfusion and optimal antithrombotic treatment, patients remain at high risk for thrombotic complications. Ongoing activation of the coagulation system as well as thrombin-mediated platelet activation may both play a crucial role in this context. Whether measurement of circulating biomarkers of coagulation and fibrinolysis could be useful for risk stratification in secondary prevention is currently not fully understood. In addition, measurement of such biomarkers could be helpful to identify thrombus formation as the leading mechanism for AMI. The introduction of biomarkers of myocardial injury such as high-sensitivity cardiac troponins made rule-out of AMI even more precise. However, elevated markers of myocardial injury cannot provide proof of a type 1 AMI, let alone thrombus formation. The combined measurement of markers of myocardial injury with biomarkers reflecting ongoing thrombus formation might be helpful for the fast and correct diagnosis of an atherothrombotic type 1 AMI. This position paper gives an overview of the current knowledge and possible role of biomarkers of coagulation and fibrinolysis for the diagnosis of AMI, risk stratification, and individualized treatment strategies in patients with AMI.
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Affiliation(s)
- Konstantin A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, Angiology, Pulmonology, Medical University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Bruna Gigante
- Unit of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden.,Department of Clinical Science, Danderyds Hospital, Entrévägen 2, 182 57 Danderyd, Sweden
| | - Diana A Gorog
- Department of Medicine, National Heart & Lung Institute, Imperial College, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
| | - Allan S Jaffe
- Department of Cardiology, Mayo Clinic, 1216 2nd St SW Rochester, MN 55902, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, 1216 2nd St SW Rochester, MN 55902, USA
| | - Johannes Mair
- Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Möckel
- Division of Emergency and Acute Medicine and Chest Pain Units, Charite - Universitätsmedizin Berlin, Campus Mitte and Virchow, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Beech Hill Rd, Sheffield S10 2RX, UK
| | - Gemma Vilahur
- Cardiovascular Program ICCC - Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Calle de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Kurt Huber
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria.,3rd Medical Department of Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160 Vienna, Austria
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Tobias Geisler
- University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Joao Morais
- Division of Cardiology, Santo Andre's Hospital, R. de Santo André, 2410-197 Leiria, Portugal
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala Clinical Research Center, Dag Hammarskjölds Väg 38, 751 85 Uppsala University, Uppsala, Sweden
| | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus N, Denmark
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25
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Rasmussen SR, Nielsen RV, Eriksson F, Dons M, Vedel AG, Buggeskov KB, Møgelvang R, Ostrowski SR, Ravn HB. Prognostic Value of Soluble Urokinase-Type Plasminogen Activator Receptor and High-Sensitivity C-Reactive Protein on Postoperative Mortality in Patients Undergoing Elective On-Pump Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 35:2415-2423. [PMID: 33243671 DOI: 10.1053/j.jvca.2020.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Elevated soluble urokinase-type plasminogen activator receptor (suPAR) and high-sensitivity C-reactive protein (hsCRP) have been associated with increased mortality in patients with cardiovascular disease. The aim of the present study was to explore the relationship between suPAR and hsCRP values and associated mortality after elective cardiac surgery. A secondary aim was to assess whether a combined risk model of European System for Cardiac Operative Risk Evaluation (EuroSCORE II), suPAR, and/or hsCRP would improve the prognostic accuracy compared with EuroSCORE II alone. DESIGN Retrospective observational study. SETTING Single-center, university hospital. PARTICIPANTS Adult patients admitted for elective on-pump cardiac surgery were included. Biobank blood samples were obtained from previous research projects at a tertiary heart center from 2012 to 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 931 patients were included. Kaplan-Meier and Cox proportional hazard analyses were used to explore a potential association between preoperative suPAR and hsCRP values and all-cause mortality up to one year after surgery. Thirty-day mortality was predicted from suPAR, hsCRP, and EuroSCORE II by logistic regression and compared using area under the receiver operating characteristics curve and Brier scores. After adjustment for known confounders, a doubling of suPAR and hsCRP corresponded to a hazard ratio for all-cause mortality of 2.27 (95% confidence interval 1.65-3.11; p < 0.001) and 1.26 (95% confidence interval 1.07-1.49; p = 0.005), respectively. However, adding the biomarkers to EuroSCORE II did not improve prediction/discrimination with respect to 30-day mortality. CONCLUSIONS Elevated preoperative levels of suPAR and hsCRP were associated with all-cause mortality in elective cardiac surgery patients. However, inclusion of biomarkers did not improve the prognostic accuracy of EuroSCORE II.
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Affiliation(s)
- Sebastian Roed Rasmussen
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Rikke Vibeke Nielsen
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frank Eriksson
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Maria Dons
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Grønborg Vedel
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katrine Bredahl Buggeskov
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Clinical Cardiovascular Research Unit, Svendborg, University of Southern Denmark, Svendborg, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Soluble urokinase plasminogen activator receptor level in individuals of advanced age. Sci Rep 2020; 10:15462. [PMID: 32963338 PMCID: PMC7508810 DOI: 10.1038/s41598-020-72377-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 08/27/2020] [Indexed: 11/08/2022] Open
Abstract
Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker whose clinical value has been tested in various groups of patients. The aim of the present study was to determine the suPAR level in a previously uninvestigated population of 182, generally healthy, community-dwelling seniors aged 74–89 years. In addition to suPAR level, selected laboratory parameters of heart and kidney function, lipid and C-reactive protein levels were determined. A group of 45 younger individuals aged 24–66 years was used for comparison. The seniors had higher suPAR levels than younger controls: 3.79 ng/mL (95% CI 3.64–3.96 ng/mL) vs. 3.16 ng/mL (95% CI 2.86–3.45 ng/mL). These levels increased further with advancing age, and were similar in women and men. A multiple regression model confirmed that biomarker level was related to cardiac function, renal function and inflammation, and this remained after adjusting for age. These correlation patterns were similar in older women and men.
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Petersen JEV, Kallemose T, Barton KD, Caspi A, Rasmussen LJH. Soluble urokinase plasminogen activator receptor (suPAR) as a prognostic marker of mortality in healthy, general and patient populations: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e036125. [PMID: 32690515 PMCID: PMC7371134 DOI: 10.1136/bmjopen-2019-036125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/11/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Chronic inflammation is increasingly recognised as a major contributor to disease, disability and ultimately death, but measuring the levels of chronic inflammation remains non-canonised, making it difficult to relate chronic inflammation and mortality. Soluble urokinase plasminogen activator receptor (suPAR), an emerging biomarker of chronic inflammation, has been proposed as a prognostic biomarker associated with future incidence of chronic disease and mortality in general as well as patient populations. Proper prognostic biomarkers are important as they can help improve risk stratification in clinical settings and provide guidance in treatment or lifestyle decisions as well as in the design of randomised trials. Here, we wish to summarise the evidence about the overall association of the biomarker suPAR with mortality in healthy, general and patient populations across diseases. METHODS AND ANALYSIS The search will be conducted using Medline, Embase and Scopus databases from their inception to 03 June 2020 to identify studies investigating 'suPAR' and 'mortality'. Observational studies and control groups from intervention studies written in English or Danish will be included. The 'Quality In Prognosis Studies' tool will be used to assess the risk of bias for the studies included. Unadjusted and adjusted mortality outcome measures (eg, risk ratios, ORs, HRs) with 95% CIs will be extracted for healthy individuals, general and patient populations. The primary outcome is all-cause mortality within any given follow-up. Subgroup analyses will be performed based on time of outcome, cause of death, population type, adjustments for conventional risk factors and inflammation markers. ETHICS AND DISSEMINATION This systematic review will synthesise evidence on the use of suPAR as a prognostic marker for mortality. The results will be disseminated by publication in a peer-reviewed journal. Data used will be obtained from published studies, and ethics approval is therefore not necessary for this systematic review. TRIAL REGISTRATION NUMBER PROSPERO CRD42020167401.
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Affiliation(s)
- Jens Emil Vang Petersen
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Karen D Barton
- Duke University Medical Center Library & Archives, Duke University, Durham, North Carolina, USA
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center for Genomic and Computational Biology, Duke University, Durham, North Carolina, USA
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
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Peiró ÓM, Cediel G, Bonet G, Rojas S, Quintern V, Carrasquer A, González-Del-Hoyo M, Sanz E, Bardají A. Soluble urokinase plasminogen activator receptor as a long-term prognostic biomarker in acute coronary syndromes. Biomarkers 2020; 25:402-409. [PMID: 32551985 DOI: 10.1080/1354750x.2020.1778090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose: The aim of our study was to analyse the long-term prognostic value of soluble urokinase plasminogen activator receptor (suPAR) in the setting of an acute coronary syndrome (ACS).Methods: We included 340 patients with an ACS who underwent coronary angiography and plasma suPAR concentration was measured. Patients were classified into low suPAR concentrations (<2.6 ng/mL) and high suPAR concentrations (≥2.6 ng/mL) and long-term events were evaluated. suPAR prognostic value was assessed beyond a clinical model that included age, GRACE score, estimated glomerular filtration rate, cardiac troponin-I peak and left ventricular ejection fraction <40%.Results: Higher suPAR concentrations were associated with an increased prevalence of cardiovascular risk factors. After multivariate adjustment, suPAR ≥2.6 ng/mL were independently associated with an increased risk of all-cause death (HR 2.3; 95%CI 1.2-4.4; p = .017), major adverse cardiovascular events (MACE) (HR 1.7; 95%CI 1.1-2.5; p = .020) and heart failure (HR 4.1; 95%CI 1.3-12.6; p = .015), but not with myocardial infarction. For long-term all-cause death significant improvement of reclassification and discrimination were seen after addition of suPAR to a clinical model.Conclusions: In the setting of an ACS, suPAR is associated with long-term all-cause death, heart failure and MACE, and provides incremental prognostic value beyond traditional risks factors.
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Affiliation(s)
- Óscar Manuel Peiró
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - German Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Gil Bonet
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Sergio Rojas
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Verónica Quintern
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Anna Carrasquer
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Maribel González-Del-Hoyo
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Esther Sanz
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Alfredo Bardají
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
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29
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Hodges G, Lyngbæk S, Selmer C, Ahlehoff O, Theilade S, Sehestedt TB, Abildgaard U, Eugen-Olsen J, Galløe AM, Hansen PR, Jeppesen JL, Bang CN. SuPAR is associated with death and adverse cardiovascular outcomes in patients with suspected coronary artery disease. SCAND CARDIOVASC J 2020; 54:339-345. [DOI: 10.1080/14017431.2020.1762917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Gethin Hodges
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Stig Lyngbæk
- Department of Medicine Glostrup, Amager Hvidvore Hospital Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Christian Selmer
- Department of Endocrinology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Thomas Berend Sehestedt
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Abildgaard
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Peter Riis Hansen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Jørgen L. Jeppesen
- Department of Medicine Glostrup, Amager Hvidvore Hospital Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Casper N. Bang
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Cardiology, North Zealand University Hospital, Hillerød, Denmark
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30
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Sandø A, Schultz M, Eugen-Olsen J, Køber L, Engstrøm T, Kelbæk H, Jørgensen E, Saunamäki K, Holmvang L, Pedersen F, Tilsted HH, Høfsten D, Helqvist S, Clemmensen P, Iversen K. Soluble urokinase receptor as a predictor of non-cardiac mortality in patients with percutaneous coronary intervention treated ST-segment elevation myocardial infarction. Clin Biochem 2020; 80:8-13. [PMID: 32213303 DOI: 10.1016/j.clinbiochem.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identification of patients at high risk of non-cardiac mortality following ST-segment elevation myocardial infarction (STEMI) could guide clinicians to identify patients who require attention due to serious non-cardiac conditions after the acute phase of STEMI. The purpose of this study was to evaluate if the non-specific and prognostic biomarker of inflammation and comorbidity, soluble urokinase receptor (suPAR), could predict non-cardiac mortality in a cohort of STEMI patients. METHODS SuPAR was measured in 1,190 STEMI patients who underwent primary percutaneous coronary intervention (pPCI). The primary endpoint was non-cardiac mortality, secondary endpoints were cardiac mortality, all-cause mortality, reinfarction and periprocedural acute kidney injury. Backwards elimination of potential confounders significantly associated with the respective outcome was used to adjust associations. RESULTS Patients were followed for a median of 3.0 years (interquartile range 2.5- 3.6 years). Multivariate cox regression revealed that a plasma suPAR level above 3.70 ng mL-1 was associated with non-cardiac and cardiac mortality at hazard ratios 3.33 (95% confidence interval 1.67-6.63, p = 0.001, adjusted for age) and 0.99 (0.18-5.30, p = 0.98, adjusted for previous myocardial infarction and left ventricular ejection fraction), respectively. CONCLUSION In patients with pPCI treated STEMI, suPAR was an independent prognostic biomarker of non-cardiac but not cardiac mortality and may identify patients with high risk of non-cardiac mortality.
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Affiliation(s)
- Andreas Sandø
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Martin Schultz
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Lars Køber
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Thomas Engstrøm
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.
| | - Erik Jørgensen
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Kari Saunamäki
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Lene Holmvang
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Frants Pedersen
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Hans Henrik Tilsted
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark.
| | - Dan Høfsten
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Steffen Helqvist
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Peter Clemmensen
- Department of General and Interventional Cardiology, University Heart Center, Hamburg-Eppendorf, Hamburg, Germany and Department of Medicine, Division of Cardiology, Nykøbing Falster Hospital, University of Southern Denmark, Fjordvej 15, 4800 Nykøbing Falster, Denmark.
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
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31
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Skovsted TA, Petersen ERB, Fruekilde MB, Pedersen AK, Pielak T, Eugen-Olsen J. Validation of suPAR turbidimetric assay on Cobas® (c502 and c702) and comparison to suPAR ELISA. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:327-335. [PMID: 32186407 DOI: 10.1080/00365513.2020.1741674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
suPAR is a plasma marker of chronic inflammation, and an elevated suPAR is consistently associated with worse outcome in a variety of clinical conditions. Quantification of suPAR is useful for determining patient risk in triage, but there is no fast automatized method for quick determination of suPAR. We developed and validated a rapid latex particle-enhanced turbidimetric immunoassay for quantification of plasma suPAR on the c502 and the c702 Roche Cobas® 8000 measurment systems. The turbidimetric assay was validated against the suPARnostic® ELISA (ViroGates, Denmark). This validation demonstrates suPAR can be analysed by turbidimetry giving very similar results (<15% difference) compared to the ELISA method and the observed correlations (n = 103) were strong, r > 0.95. Roche Cobas® 8000 instruments demonstrated repeatability and repoducibility, CV % at 3.4-4.1 and 5.7-11.4, respectively. The estimated limit of detection was 1.30 µg/L and 1.31 µg/L for the Cobas® c502 and c702, respectively. Dilution tests showed linearity of suPAR from 1.8 to 26.5 μg/L. The acceptable concentrations of Bilirubin, Intralipid and Hemoglobin, were 350 µmol/L, 3.3 g/L and 1.4 g/L, respectively. suPAR can be quantified reproducibly within 10 min using a turbidimetry assay. This assay is faster than ELISA with similar results, making it suitable for clinical routine analysis.
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Affiliation(s)
- Thor A Skovsted
- Department of Biochemistry and Immunology, Hospital of Southern Jutland, Region of Southern Denmark, Aabenraa, Denmark
| | - Eva Rabing Brix Petersen
- Department of Biochemistry and Immunology, Hospital of Southern Jutland, Region of Southern Denmark, Aabenraa, Denmark
| | - Maj-Britt Fruekilde
- Department of Biochemistry and Immunology, Hospital of Southern Jutland, Region of Southern Denmark, Aabenraa, Denmark
| | | | - Tomasz Pielak
- ViroGates A/S, Birkerød, Denmark.,NUTOPI Sp. z o. o, Poznan, Poland
| | - Jesper Eugen-Olsen
- ViroGates A/S, Birkerød, Denmark.,Clinical Research Center, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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32
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Lv L, Wang F, Wu L, Wang JW, Cui Z, Hayek SS, Wei C, Reiser J, He K, Zhang L, Chen M, Zhao MH. Soluble urokinase-type plasminogen activator receptor and incident end-stage renal disease in Chinese patients with chronic kidney disease. Nephrol Dial Transplant 2020; 35:465-470. [PMID: 30124995 PMCID: PMC9214641 DOI: 10.1093/ndt/gfy265] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/28/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Soluble urokinase-type plasminogen activator receptor (suPAR), a marker of immune activation, was shown to be associated with outcomes and kidney disease among various patient populations. The prognostic role of circulating suPAR levels in patients with chronic kidney disease (CKD) needs to be investigated in a cohort with large sample size of renal diseases. METHODS We measured serum suPAR concentration in 2391 CKD patients in the multicenter Chinese Cohort Study of Chronic Kidney Disease, and investigated the association of serum suPAR with the prespecified endpoint event, end-stage renal disease (ESRD), using Cox proportional hazards regression model. RESULTS Altogether, 407 ESRD events occurred during the median follow-up of 54.8 (interquartile range: 47.5-62.2) months. The higher levels of serum suPAR were independently associated with increased risk of incident ESRD after adjusting for potential confounders including the baseline estimated glomerular filtration rate categories, with the hazard ratios (HRs) of 1.53 [95% confidence intervals (CIs) 1.10-2.12] for the top tertile (≥3904 pg/mL) compared with the bottom tertile (<2532 pg/mL). When stratified by the etiologies of CKD, among patients with glomerulonephritis (GN), serum suPAR levels were also independently associated with the higher risk of ESRD, with an HR of 1.61 (95% CI 1.03-2.53) in the top tertile compared with the bottom tertile. CONCLUSIONS Circulating suPAR level was independently associated with an increased risk of progression to ESRD in Chinese CKD patients, especially in those with an etiology of GN.
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Affiliation(s)
| | | | - Liang Wu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Jin-Wei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Zhao Cui
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Salim S Hayek
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Changli Wei
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kevin He
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Luxia Zhang
- Correspondence and offprint requests to: Min Chen; E-mail: Luxia Zhang; E-mail:
| | - Min Chen
- Correspondence and offprint requests to: Min Chen; E-mail: Luxia Zhang; E-mail:
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
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Mehta A, Desai SR, Ko YA, Liu C, Dhindsa DS, Nayak A, Hooda A, Martini MA, Ejaz K, Sperling LS, Reiser J, Hayek SS, Quyyumi AA. Sex Differences in Circulating Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) Levels and Adverse Outcomes in Coronary Artery Disease. J Am Heart Assoc 2020; 9:e015457. [PMID: 32089048 PMCID: PMC7335555 DOI: 10.1161/jaha.119.015457] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Women have higher circulating levels of soluble urokinase‐type plasminogen activator receptor (suPAR), and elevated suPAR is associated with cardiovascular risk. The independent association of sex with suPAR and the impact of sex on its association with cardiovascular risk are unknown. Methods and Results Plasma suPAR was measured using ELISA in 2 cohorts of 666 asymptomatic individuals (49 years, 65% women) and 4184 patients with coronary artery disease (63 years, 37% women). Independent association of sex with suPAR was studied using linear regression models adjusted for demographics, risk factors, and visceral adiposity in asymptomatic participants. Impact of sex on association of suPAR with all‐cause mortality was studied in patients with coronary artery disease using multivariable‐adjusted Cox models. Sex‐specific suPAR cutoffs for predicting all‐cause mortality were calculated. Asymptomatic women had 10% higher suPAR compared with men after adjusting for confounders, and visceral adiposity partly accounted for this association. Over a median follow‐up of 5.2 years, 795 deaths were recorded in patients with coronary artery disease. Log2‐transformed suPAR was independently associated with mortality (hazard ratio per 1‐SD 1.72, 95% CI 1.60–1.85) and an interaction with sex was noted (P=0.005). Association of suPAR with mortality was slightly weaker in women (hazard ratio 1.61, 95% CI 1.41–1.83) compared with men (hazard ratio 1.83, 95% CI 1.67–2.00). However, using sex‐specific suPAR cut‐offs (4392 pg/mL for women and 3187 pg/mL for men), a similar mortality incidence was observed for both sexes (38.5% and 35.5%, respectively, P=0.3). Conclusions Women have 10% higher plasma suPAR levels compared with men. Elevated sex‐specific plasma suPAR levels are equally predictive of risk of adverse events in both sexes.
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Affiliation(s)
- Anurag Mehta
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Shivang R Desai
- Department of Medicine Emory University School of Medicine Atlanta GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics Emory University Atlanta GA
| | - Chang Liu
- Department of Biostatistics and Bioinformatics Emory University Atlanta GA
| | - Devinder S Dhindsa
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Aditi Nayak
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Ananya Hooda
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Mohamed A Martini
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Kiran Ejaz
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Laurence S Sperling
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Jochen Reiser
- Department of Internal Medicine Rush University Medical Center Chicago IL
| | - Salim S Hayek
- Frankel Cardiovascular Center University of Michigan Ann Arbor MI
| | - Arshed A Quyyumi
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
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Rasmussen LJH, Moffitt TE, Arseneault L, Danese A, Eugen-Olsen J, Fisher HL, Harrington H, Houts R, Matthews T, Sugden K, Williams B, Caspi A. Association of Adverse Experiences and Exposure to Violence in Childhood and Adolescence With Inflammatory Burden in Young People. JAMA Pediatr 2020; 174:38-47. [PMID: 31682707 PMCID: PMC6830440 DOI: 10.1001/jamapediatrics.2019.3875] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Childhood stress exposure is associated with inflammation as measured by C-reactive protein (CRP) and interleukin 6 (IL-6). However, findings are inconsistent and effect sizes are small. The addition of soluble urokinase plasminogen activator receptor (suPAR), a new biomarker of chronic inflammation, may improve measurement of stress-related inflammatory burden. OBJECTIVES To assess whether exposure to adverse experiences, stress, and violence is associated with an increase in suPAR levels in young people and to test the hypothesis that measuring suPAR in addition to CRP or IL-6 levels improves the assessment of the inflammatory burden associated with early-life stress. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 1391 participants from a 1994 to 1995 birth cohort of twins from the nationally representative Environmental Risk Longitudinal Twin Study in the United Kingdom. Participants were followed up until 18 years of age (93% retention). Plasma samples were analyzed in July 2018, and statistical analysis was performed from October 1, 2018, to May 31, 2019. EXPOSURES Adverse childhood experiences and childhood and adolescent experience of stress and violence exposure. MAIN OUTCOMES AND MEASURES Plasma CRP, IL-6, and suPAR levels at 18 years of age. RESULTS Among 1391 young people (mean [SD] age, 18.4 [0.36] years; 733 [52.7%] female), those who had been exposed to stressful experiences had elevated suPAR levels by 18 years of age after controlling for sex, body mass index, and smoking: 0.03-ng/mL (95% CI, 0.01-0.05 ng/mL) increase in suPAR per each additional adverse childhood experience, 0.09-ng/mL (95% CI, 0.01-0.17 ng/mL) increase in suPAR per each additional severe childhood experience of stress or violence, and 0.04-ng/mL (95% CI, -0.02 to 0.10 ng/mL) increase in suPAR per each additional severe adolescent experience of stress or violence. Individuals exposed to multiple types of violence in both childhood and adolescence had 0.26-ng/mL (95% CI, 0.07-0.45 ng/mL) higher suPAR levels compared with children who did not experience stress or violence. These stress-exposed young people were significantly more likely to have elevated suPAR levels at 18 years of age even if they did not have elevated CRP or IL-6 levels. Measuring suPAR in addition to CRP or IL-6 increased the association between stress exposure and inflammatory burden. For example, after adjusting for CRP and IL-6 levels, each additional adverse childhood experience was associated with a 0.05-mL (95% CI, 0.03-0.07 ng/mL) increase in suPAR, each additional severe childhood experience of stress or violence was associated with a 0.14-ng/mL (95% CI, 0.06-0.22 ng/mL) increase in suPAR, and each additional severe adolescent experience of stress or violence was associated with a 0.10-ng/mL (95% CI, 0.04-0.16 ng/mL) increase in suPAR. CONCLUSIONS AND RELEVANCE The results suggest that adult inflammation is associated with childhood exposure to stress. Adding information about suPAR to traditional biomarkers of inflammation may improve the measurement of inflammatory burden associated with exposure to stress and violence.
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Affiliation(s)
- Line Jee Hartmann Rasmussen
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina,Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Terrie E. Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina,Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Louise Arseneault
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Andrea Danese
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom,National and Specialist Child and Adolescent Mental Health Services Trauma, Anxiety, and Depression Clinic, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Helen L. Fisher
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - HonaLee Harrington
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Renate Houts
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Timothy Matthews
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Karen Sugden
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Benjamin Williams
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina,Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
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Rasmussen LJH, Ladelund S, Haupt TH, Ellekilde GE, Eugen-Olsen J, Andersen O. Combining National Early Warning Score With Soluble Urokinase Plasminogen Activator Receptor (suPAR) Improves Risk Prediction in Acute Medical Patients: A Registry-Based Cohort Study. Crit Care Med 2019; 46:1961-1968. [PMID: 30247244 PMCID: PMC6250248 DOI: 10.1097/ccm.0000000000003441] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives: Soluble urokinase plasminogen activator receptor is a prognostic biomarker associated with critical illness, disease progression, and risk of mortality. We aimed to evaluate whether soluble urokinase plasminogen activator receptor adds prognostic value to a vital sign-based score for clinical monitoring of patient risk (National Early Warning Score) in acute medical patients. Design: Registry-based observational cohort study of consecutively admitted acute medical patients. Setting: The Acute Medical Unit, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark. Patients: Acute medical patients admitted between November 18, 2013, and September 30, 2015. Interventions: None. Measurements and Main Results: Of 17,312 included patients, admission National Early Warning Score was available for 16,244 (93.8%). During follow-up, 587 patients (3.4%) died in-hospital, 859 (5.0%) within 30 days, and 1,367 (7.9%) within 90 days. High soluble urokinase plasminogen activator receptor was significantly associated with in-hospital-, 30-day-, and 90-day mortality within all National Early Warning Score groups, in particular in patients with a low National Early Warning Score; for 30-day mortality, mortality rate ratios ranged from 3.45 (95% CI, 2.91–4.10) for patients with National Early Warning Score 0–1, to 1.86 (95% CI, 1.47–2.34) for patients with National Early Warning Score greater than or equal to 9 for every doubling in soluble urokinase plasminogen activator receptor (log2-transformed). Combining National Early Warning Score, age, and sex with soluble urokinase plasminogen activator receptor improved prediction of in-hospital-, 30-day-, and 90-day mortality, increasing the area under the curve (95% CI) for 30-day mortality from 0.86 (0.85–0.87) to 0.90 (0.89–0.91), p value of less than 0.0001, with a negative predictive value of 99.0%. Conclusions: The addition of soluble urokinase plasminogen activator receptor to National Early Warning Score significantly improved risk prediction of both low- and high-risk acute medical patients. Patients with low National Early Warning Score but elevated soluble urokinase plasminogen activator receptor had mortality risks comparable to that of patients with higher National Early Warning Score.
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Affiliation(s)
- Line J H Rasmussen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Steen Ladelund
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas H Haupt
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Gertrude E Ellekilde
- The Acute Medical Unit, The Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Quality and Patient Safety, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
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Chew-Harris J, Appleby S, Richards AM, Troughton RW, Pemberton CJ. Analytical, biochemical and clearance considerations of soluble urokinase plasminogen activator receptor (suPAR) in healthy individuals. Clin Biochem 2019; 69:36-44. [PMID: 31129182 DOI: 10.1016/j.clinbiochem.2019.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Soluble urokinase plasminogen activator receptor (suPAR) is an emerging marker of cardiovascular disease burden. Appropriate assessment of assay performance and reference interval are required to enable interpretation of results to facilitate its clinical application. METHODS suPAR was measured using the suPARnostic® ELISA in 155 healthy volunteers. Assay performance was assessed for anticoagulant effect, recovery, interference, linearity and cross-reactivity. The identity of immunoreactive suPAR was confirmed by size-exclusion HPLC. To establish anatomical sites of release and uptake, we measured suPAR in regional samples from subjects undergoing cardiac catheterization. RESULTS The median concentration of suPAR was 2.1 ng/mL (IQR:1.7-2.3) in health. In comparison with EDTA, suPAR measurements were affected by lithium heparin (>10% change) and increased with serum usage. suPAR reactivity also increased in the presence of haemolysis (10 g/L), but was suppressed with urokinase and lipids (4 g/L). In multiple regression analyses, suPAR associated independently with body weight, NT-proBNP and MR-proADM (P = .03) for healthy individuals. Regional plasma sampling showed lower suPAR concentrations in the coronary sinus and renal vein compared with concentrations in femoral arterial samples. Immunoreactive circulating suPAR species had Mr of 10-39 kDa. CONCLUSION The suPARnostic® assay performs acceptably for a clinical assay but is limited in the presence of high levels of hemolysis, lipids and urokinase. We provide the first evidence for the heart and kidneys as organs of suPAR clearance in humans. Additional investigations are warranted to determine whether there is a need to compare the marker performance of differing circulating forms of suPAR.
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Affiliation(s)
- Janice Chew-Harris
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
| | - Sarah Appleby
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Cardiovascular Research Institute, National University of Singapore, Singapore; Department of Cardiology, Canterbury District Health Board, Christchurch, New Zealand
| | - Richard W Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Department of Cardiology, Canterbury District Health Board, Christchurch, New Zealand
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Sommerer C, Zeier M, Morath C, Reiser J, Scharnagl H, Stojakovic T, Delgado GE, März W, Kleber ME. Soluble urokinase plasminogen activation receptor and long-term outcomes in persons undergoing coronary angiography. Sci Rep 2019; 9:475. [PMID: 30679668 PMCID: PMC6346054 DOI: 10.1038/s41598-018-36960-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/23/2018] [Indexed: 12/20/2022] Open
Abstract
Soluble urokinase plasminogen activation receptor (suPAR) is risk factor for kidney disease and biomarker for cardiovascular outcomes but long term longitudinal analyses in a large European cohort have not been perfomed. To hus, we studied suPAR in participants of the Ludwigshafen Risk and Cardiovascular Health study over a very long follow-up time of nearly 10 years. We estimated overall risk of all-cause and cardiovascular death by Cox proportional hazards regression according to quartiles of suPAR, including age, sex, use of lipid-lowering drugs, body mass index, diabetes mellitus, hypertension, smoking, lipids, as well as glomerular filtration rate (eGFR), NT-proBNP, interleukin-6 and high-sensitive CRP as covariates. A total of 2940 participants (age 62.7 ± 10.5years) having a median eGFR of 83.8 mL/min/1.73 m2 were included. The median suPAR concentration was 3010 pg/mL (interquartile range, 2250–3988 pg/mL). Using the lowest quartile of suPAR as the reference, crude hazard ratio for cardiovascular mortality were 1.58 (95% CI 1.16–2.16), 1.85 (95% CI 1.37–2.52) and 2.75 (95% CI 2.03–3.71) in the second, third and fourth quartile, respectively. Adjusting for NT-proBNPeGFR or inflammation (interleukin-6 and high-sensitive CRP) confirmed results. suPAR predicts all-cause and cardiovascular death over a period of ten years in persons undergoing coronary angiography, independent of the natriuretic peptide NT-proBNP, kidney function and of markers of systemic inflammation. Future investigation into a potential causal role of suPAR in cardiovascular disease is warranted.
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Affiliation(s)
- Claudia Sommerer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, 1735 West Congress Parkway, Suite 1004, Chicago, IL, 60612, USA
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Graciela E Delgado
- Vth Department of Medicine, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Vth Department of Medicine, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
| | - Marcus E Kleber
- Vth Department of Medicine, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
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Haupt TH, Rasmussen LJH, Kallemose T, Ladelund S, Andersen O, Pisinger C, Eugen-Olsen J. Healthy lifestyles reduce suPAR and mortality in a Danish general population study. IMMUNITY & AGEING 2019; 16:1. [PMID: 30679937 PMCID: PMC6343248 DOI: 10.1186/s12979-018-0141-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022]
Abstract
Background The plasma level of the inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) is a strong predictor of disease development and premature mortality in the general population. Unhealthy lifestyle habits such as smoking or unhealthy eating is known to elevate the suPAR level. We aimed to investigate whether change in lifestyle habits impact on the suPAR level, and whether the resultant levels are associated with mortality. Results Paired suPAR measurements from baseline- and the 5-year visit of the population-based Inter99 study were compared with the habits of diet, smoking, alcohol consumption, and physical activity. Paired suPAR measurements for 3225 individuals were analyzed by linear regression, adjusted for demographics and lifestyle habits. Compared to individuals with a healthy lifestyle, an unhealthy diet, low physical activity, and daily smoking were associated with a 5.9, 12.8, and 17.6% higher 5-year suPAR, respectively. During 6.1 years of follow-up after the 5-year visit, 1.6% of those with a low suPAR (mean 2.93 ng/ml) died compared with 3.8% of individuals with a high suPAR (mean 4.73 ng/ml), P < 0.001. In Cox regression analysis, adjusted for demographics and lifestyle, the hazard ratio for mortality per 5-year suPAR doubling was 2.03 (95% CI: 1.22-3.37). Conclusion Lifestyle has a considerable impact on suPAR levels; the combination of unhealthy habits was associated with 44% higher 5-year suPAR values and the 5-year suPAR was a strong predictor of mortality. We propose suPAR as a candidate biomarker for lifestyle changes as well as the subsequent risk of mortality.
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Affiliation(s)
- Thomas Huneck Haupt
- 1Clinical Research Centre, Amager and Hvidovre Hospital, Hvidovre, Denmark.,2Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Line Jee Hartmann Rasmussen
- 1Clinical Research Centre, Amager and Hvidovre Hospital, Hvidovre, Denmark.,2Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kallemose
- 1Clinical Research Centre, Amager and Hvidovre Hospital, Hvidovre, Denmark.,2Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,3Department of Orthopedic Surgery, Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Steen Ladelund
- 1Clinical Research Centre, Amager and Hvidovre Hospital, Hvidovre, Denmark.,2Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- 1Clinical Research Centre, Amager and Hvidovre Hospital, Hvidovre, Denmark.,2Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotta Pisinger
- 4Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,5Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Eugen-Olsen
- 1Clinical Research Centre, Amager and Hvidovre Hospital, Hvidovre, Denmark.,2Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Wlazeł RN, Migała M, Zielińska M, Pawlicki L, Rośniak-Bąk K, Szadkowska I. Soluble urokinase plasminogen activator receptor in one-year prediction of major adverse cardiac events in patients after first myocardial infarction treated with primary percutaneous coronary intervention. Arch Med Sci 2019; 15:72-77. [PMID: 30697255 PMCID: PMC6348361 DOI: 10.5114/aoms.2016.63596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/09/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Soluble urokinase plasminogen activator receptor (suPAR) level reflects the general condition of the organism and was proved to give independent information in risk stratification of patients. The aim of this study was to assess the usefulness of suPAR in the prediction of adverse cardiac events in patients with first myocardial infarction (MI) undergoing primary percutaneous coronary intervention. Additionally, the diagnostic power of suPAR was assessed. MATERIAL AND METHODS One hundred and thirty-nine of 150 consecutive patients were included in the study. Serum suPAR level (ELISA, Virogates) as well as C-reactive protein (on admission and at discharge) and maximum troponin T (assessed from successive 6-hour periods of blood collection) were measured. In the 1-year follow-up study the following major adverse cardiac events were observed: myocardial infarction, revascularization, stroke and death. RESULTS Multi-variable analysis revealed prognostic usefulness only for suPAR and glomerular filtration rate: p < 0.0001 and p = 0.018; OR = 2.59 and OR = 0.98 respectively, with area under the curve in receiver operating characteristic analysis for both parameters simultaneously 0.89 (p < 0.0001). There was no correlation between suPAR level and the left ventricular dysfunction parameters or the MI type. CONCLUSIONS Soluble urokinase plasminogen activator receptor level appears to be an independent useful biomarker for the prediction of major adverse cardiac events early after first myocardial infarction. The biomarker's level seems to have more prognostic than diagnostic power.
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Affiliation(s)
- Rafał N Wlazeł
- Department of Laboratory Diagnostics and Clinical Biochemistry, Medical University of Lodz, Lodz, Poland
| | - Marta Migała
- Department of Intensive Cardiac Therapy, Medical University of Lodz, Lodz, Poland
| | - Marzenna Zielińska
- Department of Intensive Cardiac Therapy, Medical University of Lodz, Lodz, Poland
| | - Lucjan Pawlicki
- Department of Internal Diseases and Cardiological Rehabilitation, Medical University of Lodz, Lodz, Poland
| | - Kinga Rośniak-Bąk
- Department of Laboratory Diagnostics and Clinical Biochemistry, Medical University of Lodz, Lodz, Poland
| | - Iwona Szadkowska
- Department of Internal Diseases and Cardiological Rehabilitation, Medical University of Lodz, Lodz, Poland
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Serum Urokinase-Type Plasminogen Activator Receptor Does Not Outperform C-Reactive Protein and Procalcitonin as an Early Marker of Severity of Acute Pancreatitis. J Clin Med 2018; 7:jcm7100305. [PMID: 30262764 PMCID: PMC6210514 DOI: 10.3390/jcm7100305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/15/2018] [Accepted: 09/19/2018] [Indexed: 12/27/2022] Open
Abstract
Severe acute pancreatitis (SAP) concerns 10–20% of acute pancreatitis (AP) patients and is associated with a poor prognosis and high mortality. An early prognosis of the unfavorable outcome, transfer to an intensive care unit (ICU) and the introduction of an adequate treatment are crucial for patients’ survival. Recently, the elevated circulating urokinase-type plasminogen activator receptor (uPAR) has been reported to predict SAP with a high diagnostic accuracy among patients in a tertiary center. The aim of the study was to compare the diagnostic utility of uPAR and other inflammatory markers as the predictors of the unfavorable course of AP in patients admitted to a secondary care hospital within the first 24 h of the onset of AP. The study included 95 patients, eight with a SAP diagnosis. Serum uPAR was measured on admission and in the two subsequent days. On admission, uPAR significantly predicted organ failure, acute cardiovascular failure, acute kidney injury, the need for intensive care, and death. The diagnostic accuracy of the admission uPAR for the prediction of SAP, organ failure, and ICU transfer or death was low to moderate and did not differ significantly from the diagnostic accuracy of interleukin-6, C-reactive protein, procalcitonin, D-dimer and soluble fms-like tyrosine kinase-1. In the secondary care hospital, where most patients with AP are initially admitted, uPAR measurements did not prove better than the currently used markers.
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Wu W, Cui Y, Hu J, Liao R, Li S, Mo L, Xu L, Chen Y, Lian Z, Tian X, Li Z, Li R, Zhang L, Liang H, Ma J, Lin T, Feng Z, Dong W, Ke G, Ge P, Ye Z, Wang W, Zhang B, Shi W, Liang X, Liu S. Soluble Urokinase Plasminogen Activator Receptor is Associated with Coronary Artery Calcification and Cardiovascular Disease in Patients Undergoing Hemodialysis. Kidney Blood Press Res 2018; 43:664-672. [PMID: 29734173 DOI: 10.1159/000489623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Cardiovascular disease (CVD) is an important cause of morbidity and mortality in hemodialysis patients. Vascular calcification is thought to play an important role in causing CVD. Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker strongly predictive of cardiovascular outcomes in the pathogenesis of diabetic patients with renal disease treated with hemodialysis. We investigated the relationship between suPAR and coronary artery calcification (CAC) in patients undergoing maintenance hemodialysis. METHODS A total of 99 adult hemodialysis patients were enrolled in this study. Plasma samples were analyzed for suPAR with an enzyme-linked immunosorbent assay and the CAC score was determined with multidetector computed tomography. The occurrence of cardiovascular events and all-cause mortality during follow-up were recorded from January 1, 2010 to June 1, 2016. RESULTS In 99 patients treated with maintenance hemodialysis, 91 (91.9%) had varying degrees of CAC, and suPAR correlated positively with the CAC score in a Spearman analysis. In a mean follow-up period of 33 months, 36 patients (36.4%) experienced at least one cardiovascular event. When the quartiles of suPAR concentrations were used as the cutoff points for a subgroup analysis, the incidence of CVD and all-cause mortality was much higher in the higher quartiles of suPAR. In a univariate Cox regression analysis, high suPAR was a risk factor for CVD and all-cause mortality. CONCLUSION suPAR is associated with the CAC score and is a risk factor for new-onset CVD in patients undergoing hemodialysis.
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Affiliation(s)
- Wenjuan Wu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Yanhai Cui
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Juan Hu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Ruyi Liao
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Sijia Li
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Liyi Mo
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Lixia Xu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Yuanhan Chen
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Zhiwen Lian
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Xiulan Tian
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Zhuo Li
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Ruizhao Li
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Li Zhang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Huaban Liang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Jianchao Ma
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Ting Lin
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Zhonglin Feng
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Wei Dong
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Guibao Ke
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Pingjiang Ge
- Department of Otolaryngology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Zhiming Ye
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Wenjiang Wang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Bing Zhang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Wei Shi
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
| | - Xinling Liang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China,
| | - Shuangxin Liu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou, China
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Hayek SS, Divers J, Raad M, Xu J, Bowden DW, Tracy M, Reiser J, Freedman BI. Predicting Mortality in African Americans With Type 2 Diabetes Mellitus: Soluble Urokinase Plasminogen Activator Receptor, Coronary Artery Calcium, and High-Sensitivity C-Reactive Protein. J Am Heart Assoc 2018; 7:JAHA.117.008194. [PMID: 29716888 PMCID: PMC6015289 DOI: 10.1161/jaha.117.008194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus is a major risk factor for cardiovascular disease; however, outcomes in individual patients vary. Soluble urokinase plasminogen activator receptor (suPAR) is a bone marrow-derived signaling molecule associated with adverse cardiovascular and renal outcomes in many populations. We characterized the determinants of suPAR in African Americans with type 2 diabetes mellitus and assessed whether levels were useful for predicting mortality beyond clinical characteristics, coronary artery calcium (CAC), and high-sensitivity C-reactive protein (hs-CRP). METHODS AND RESULTS We measured plasma suPAR levels in 500 African Americans with type 2 diabetes mellitus enrolled in the African American-Diabetes Heart Study. We used Kaplan-Meier curves and Cox proportional hazards models adjusting for clinical characteristics, CAC, and hs-CRP to examine the association between suPAR and all-cause mortality. Last, we report the change in C-statistics comparing the additive values of suPAR, hs-CRP, and CAC to clinical models for prediction of mortality. The suPAR levels were independently associated with female sex, smoking, insulin use, decreased kidney function, albuminuria, and CAC. After a median 6.8-year follow-up, a total of 68 deaths (13.6%) were recorded. In a model incorporating suPAR, CAC, and hs-CRP, only suPAR was significantly associated with mortality (hazard ratio 2.66, 95% confidence interval 1.63-4.34). Addition of suPAR to a baseline clinical model significantly improved the C-statistic for all-cause death (Δ0.05, 95% confidence interval 0.01-0.10), whereas addition of CAC or hs-CRP did not. CONCLUSIONS In African Americans with type 2 diabetes mellitus, suPAR was strongly associated with mortality and improved risk discrimination metrics beyond traditional risk factors, CAC and hs-CRP. Studies addressing the clinical usefulness of measuring suPAR concentrations are warranted.
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Affiliation(s)
- Salim S Hayek
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mohamad Raad
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jianzhao Xu
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
| | - Donald W Bowden
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC.,Centers for Diabetes Research and Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC
| | - Melissa Tracy
- Department of Medicine, Rush University, Chicago, IL
| | - Jochen Reiser
- Department of Medicine, Rush University, Chicago, IL
| | - Barry I Freedman
- Centers for Diabetes Research and Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC.,Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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Westin O, Rasmussen LJH, Andersen O, Buch E, Olsen JE, Friberg J. Soluble Urokinase Plasminogen Activator Receptor (suPAR) as a Predictor of Incident Atrial Fibrillation. J Atr Fibrillation 2018; 10:1801. [PMID: 29988279 PMCID: PMC6009789 DOI: 10.4022/jafib.1801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/19/2018] [Accepted: 03/14/2018] [Indexed: 11/10/2022]
Abstract
Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker of chronic low-grade inflammation and a potent predictor of cardiovascular events. We hypothesized that plasma suPAR levels would predict new-onset atrial fibrillation (AF) in a large cohort of con-secutively admitted acute medical patients during long-term follow-up. In 14,764 acutely ad-mitted patients without prior or current AF, median suPAR measured upon admission was 2.7 ng/ml (interquartile range (IQR) 1.9-4.0). During a median follow-up of 392 days (IQR 218-577), 349 patients (2.4%) were diagnosed with incident AF. suPAR levels at admission significantly predicted subsequent incident AF (HR per doubling of suPAR: 1.21, 95% CI 1.05-1.41, adjusted for age and sex). After further adjustment for Charlson score, plasma C-reactive protein (CRP), plasma creatinine and blood hemoglobin-levels, the result remained essentially unaltered (HR per doubling of suPAR: 1.20, 95% CI: 1.01-1.42). In multivariate ROC curve analysis, combining age, sex, Charlson score, CRP, creatinine, and hemoglobin (AUC 0.77, 95% CI 0.75-0.79), the addition of suPAR did not improve the prediction of incident AF (AUC 0.77, 95% CI 0.75-0.79, P=0.89). Plasma suPAR is independently associated with subsequent new-onset AF in a population of recently hospitalized patients, but the addition of suPAR to baseline risk markers appears not to improve the prediction of AF.
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Affiliation(s)
- Oscar Westin
- Department of Cardiology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | | | - Ove Andersen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Eric Buch
- Department of Cardiology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jesper Eugen- Olsen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jens Friberg
- Department of Cardiology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
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44
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Onatsu J, Taina M, Mustonen P, Hedman M, Muuronen A, Arponen O, Korhonen M, Jäkälä P, Vanninen R, Pulkki K. Soluble Urokinase-type Plasminogen Activator Receptor Predicts All-cause 5-Year Mortality in Ischemic Stroke and TIA. ACTA ACUST UNITED AC 2018; 31:381-386. [PMID: 28438866 DOI: 10.21873/invivo.11070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/26/2017] [Accepted: 03/01/2017] [Indexed: 12/26/2022]
Abstract
AIM We evaluated soluble urokinase-type plasminogen activator receptor (suPAR) levels in different stroke subtypes and assessed their prognostic value regarding 5-year outcomes. MATERIALS AND METHODS The study included 117 stroke patients (81 males; mean=age 61±11 years) with suspected cardioembolic stroke whose plasma suPAR concentration was assessed. Altogether, 20 (17.1%) patients suffered from stroke as a result of cardioembolism, 12 (10.3%) from large-artery atherosclerosis, 9 (7.7%) from small-vessel disease, 11 (9.4%) from both large-artery and cardioembolic etiology, and 65 (55.6%) had cryptogenic stroke. The mean follow-up period was 5 years. RESULTS suPAR concentration was higher in patients who suffered from stroke/transient ischemic attack due to large-artery atherosclerosis (3.2±0.9 ng/ml) compared to small-vessel disease (2.0±0.5 ng/ml, p<0.001). An elevated plasma suPAR concentration was associated with all-cause mortality during the follow-up period (p=0.003). CONCLUSION Elevated plasma suPAR concentrations predicted all-cause mortality during the 5-year follow-up after ischemic stroke. suPAR was not able to differentiate patients with cardioembolic stroke from those with other stroke types.
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Affiliation(s)
- Juha Onatsu
- Department of Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Pirjo Mustonen
- Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Antti Muuronen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Otso Arponen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Miika Korhonen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Jäkälä
- Department of Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland.,Eastern Finland Laboratory Centre, Kuopio, Finland
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45
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Soluble Urokinase-Type Plasminogen Activator Receptor Improves Risk Prediction in Patients With Chronic Heart Failure. JACC-HEART FAILURE 2018; 5:268-277. [PMID: 28359415 DOI: 10.1016/j.jchf.2016.12.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/08/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study investigated the predictive value of soluble urokinase-type plasminogen activator receptor (suPAR) in patients with chronic heart failure (CHF). BACKGROUND SuPAR originates from proteolytic cleavage of the membrane-bound receptor from activated immune and endothelial cells and reflects the level of immune activation. As inflammation plays a crucial role in the complex pathophysiology of CHF, we hypothesized that suPAR might be a suitable prognostic biomarker in patients with CHF. METHODS SuPAR levels were determined in 319 patients with CHF admitted to our outpatient department for heart failure and in a second cohort consisting of 346 patients with CHF, for validation. RESULTS During a median follow-up time of 3.2 years, 119 patients (37.3%) died. SuPAR was a strong predictor of mortality with a crude hazard ratio (HR) per increase of 1 SD (HR per 1 SD) of 1.96 (95% confidence interval [CI]: 1.63 to 2.35; p < 0.001) in univariate analysis and remained significant after comprehensive multivariate adjustment with an adjusted HR per 1 SD of 1.38 (95% CI: 1.04 to 1.83; p = 0.026). SuPAR added prognostic value beyond the multivariate model indicated by improvements in C-statistics (area under the curve: 0.72 vs 0.74, respectively; p = 0.02), the category-free net reclassification index (24.9%; p = 0.032), and the integrated discrimination improvement (0.011; p = 0.05). Validation in the second cohort yielded consistent results. CONCLUSIONS SuPAR is a strong and independent predictor of mortality in patients with CHF, potentially suitable to refine risk assessment in this vulnerable group of patients. Our results emphasize the impact of immune activation on survival in patients with CHF.
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Dhindsa DS, Khambhati J, Sandesara PB, Eapen DJ, Quyyumi AA. Biomarkers to Predict Cardiovascular Death. Card Electrophysiol Clin 2017; 9:651-664. [PMID: 29173408 DOI: 10.1016/j.ccep.2017.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This article reviews biomarkers that have been shown to identify subjects at increased risk for cardiovascular death within the general population, in those with established coronary artery disease, and in those with heart failure. Use of biomarkers for risk stratification for sudden cardiac death continues to evolve. It seems that a multimarker strategy for risk stratification using simple measures of circulating proteins and usual clinical risk factors, particularly in patients with known coronary artery disease, can be used to identify patients at near-term risk of death. Whether similar strategies in the general population will prove to be cost-effective needs to be investigated.
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Affiliation(s)
- Devinder S Dhindsa
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Jay Khambhati
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Danny J Eapen
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA.
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Koh AS, Velmurugan B, Gao F, Tan RS, Wong JI, Teo LLY, Keng BMH, Chua SJM, Yuan JM, Koh WP, Cheung C. Value of soluble Urokinase plasminogen activator receptor over age as a biomarker of impaired myocardial relaxation. BMC Geriatr 2017; 17:275. [PMID: 29179674 PMCID: PMC5704352 DOI: 10.1186/s12877-017-0668-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022] Open
Abstract
Background SuPAR is a biomarker that reflects the level of immune activation. As inflammation plays an important role in the ageing process of the cardiovascular system, we hypothesized that suPAR might be a useful predictive biomarker of the ageing heart. Methods We performed conventional and tissue Doppler echocardiography and measured plasma suPAR levels. Results We studied community adults (n=120, 37.5% female) (mean age: 70.3±9.3 years) without known cardiovascular disease (CVD). Participants with impaired myocardial relaxation were older (84% vs 59% were aged ≥71 years, p=0.002), with more diabetes mellitus (27% vs 11%, p=0.034). SuPAR levels were higher among participants with impaired myocardial relaxation (3.9 ng/ml vs 3.0 ng/ml, p=0.015). At the univariate level, older age (OR 3.6; 95%CI 1.6, 8.5; p=0.003), diabetes mellitus (OR 3.04; 95%CI 1.1, 8.8; p=0.04), systolic blood pressure (OR 1.03; 95%CI 1.001, 1.1; p=0.041) and suPAR levels ≥3.00ng/ml (OR 3.4; 95%CI 1.16, 7.4; p=0.002) were associated with impaired myocardial relaxation. In multivariable regression analysis, only older age (OR 2.8; 95%CI 1.1, 6.7; p=0.026) and suPAR (OR 2.7; 95%CI 1.2, 6.1; p=0.018) remained independently associated with impaired myocardial relaxation. Receiver operating characteristics (ROC) curve analysis revealed an area under the curve (AUC) value of 0.63 (95% CI 0.54, 0.71) for model that included age alone. Addition of suPAR significantly increased AUC value to 0.70 (95%CI 0.60, 0.79), which was significantly larger than the model with age alone (p=0.016). Conclusion We demonstrate additional ability of suPAR, over age, to predict impaired myocardial relaxation. Trial registration ClinicalTrials.gov Identifier: NCT02791139 (Registered May 31, 2016).
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Affiliation(s)
- Angela S Koh
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
| | - Bhaarathy Velmurugan
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Fei Gao
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ru San Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jia-Ing Wong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Louis L Y Teo
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Bryan M H Keng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Serene J M Chua
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Woon-Puay Koh
- Duke-NUS Medical School, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Christine Cheung
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Ghasemzedah N, Hayek SS, Ko YA, Eapen DJ, Patel RS, Manocha P, Al Kassem H, Khayata M, Veledar E, Kremastinos D, Thorball CW, Pielak T, Sikora S, Zafari AM, Lerakis S, Sperling L, Vaccarino V, Epstein SE, Quyyumi AA. Pathway-Specific Aggregate Biomarker Risk Score Is Associated With Burden of Coronary Artery Disease and Predicts Near-Term Risk of Myocardial Infarction and Death. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.115.001493. [PMID: 28280039 DOI: 10.1161/circoutcomes.115.001493] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/11/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inflammation, coagulation, and cell stress contribute to atherosclerosis and its adverse events. A biomarker risk score (BRS) based on the circulating levels of biomarkers C-reactive protein, fibrin degradation products, and heat shock protein-70 representing these 3 pathways was a strong predictor of future outcomes. We investigated whether soluble urokinase plasminogen activator receptor (suPAR), a marker of immune activation, is predictive of outcomes independent of the aforementioned markers and whether its addition to a 3-BRS improves risk reclassification. METHODS AND RESULTS C-reactive protein, fibrin degradation product, heat shock protein-70, and suPAR were measured in 3278 patients undergoing coronary angiography. The BRS was calculated by counting the number of biomarkers above a cutoff determined using the Youden's index. Survival analyses were performed using models adjusted for traditional risk factors. A high suPAR level ≥3.5 ng/mL was associated with all-cause death and myocardial infarction (hazard ratio, 1.83; 95% confidence interval, 1.43-2.35) after adjustment for risk factors, C-reactive protein, fibrin degradation product, and heat shock protein-70. Addition of suPAR to the 3-BRS significantly improved the C statistic, integrated discrimination improvement, and net reclassification index for the primary outcome. A BRS of 1, 2, 3, or 4 was associated with a 1.81-, 2.59-, 6.17-, and 8.80-fold increase, respectively, in the risk of death and myocardial infarction. The 4-BRS was also associated with severity of coronary artery disease and composite end points. CONCLUSIONS SuPAR is independently predictive of adverse outcomes, and its addition to a 3-BRS comprising C-reactive protein, fibrin degradation product, and heat shock protein-70 improved risk reclassification. The clinical utility of using a 4-BRS for risk prediction and management of patients with coronary artery disease warrants further study.
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Affiliation(s)
- Nima Ghasemzedah
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Salim S Hayek
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Yi-An Ko
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Danny J Eapen
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Riyaz S Patel
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Pankaj Manocha
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Hatem Al Kassem
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Mohamed Khayata
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Emir Veledar
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Dimitrios Kremastinos
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Christian W Thorball
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Tomasz Pielak
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Sergey Sikora
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - A Maziar Zafari
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Stamatios Lerakis
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Laurence Sperling
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Viola Vaccarino
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Stephen E Epstein
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Arshed A Quyyumi
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.).
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Soluble Urokinase Plasminogen Activator Receptor and the Risk of Coronary Artery Disease in Young Chinese Patients. DISEASE MARKERS 2017; 2017:4719403. [PMID: 29109596 PMCID: PMC5646332 DOI: 10.1155/2017/4719403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 09/20/2017] [Indexed: 01/14/2023]
Abstract
Background Soluble urokinase plasminogen activator receptor (suPAR) is a novel marker of chronic inflammation and is considered to be a risk factor for coronary artery disease (CAD) in Caucasians. This study investigated the role of suPAR in young Chinese patients with CAD. Methods The study involved a total of 196 consecutive young (age ≤ 55 years) patients with angiographically proven CAD and 188 age-matched non-CAD individuals as controls. Traditional risk factors were evaluated using conventional assays, and levels of suPAR were measured by sandwich enzyme-linked immunosorbent assays. Results Levels of suPAR were significantly correlated with age (r = 0.20, P = 0.04), smoking (r = 0.33, P = 0.008), body mass index (r = 0.21, P = 0.03), and high-sensitivity C-reactive protein (hs-CRP; r = 0.31, P = 0.01). Multivariate logistic regression analysis showed that male sex (odds ratio (OR) = 3.12; 95% confidence interval (CI) = 1.18–8.25, P = 0.02), smoking (OR = 3.41, 95% CI = 1.55–7.50, P = 0.002), triglyceride (OR = 1.89, 95% CI = 1.10–3.25, P = 0.02), high-sensitivity C-reactive protein (OR = 1.24, 95% CI = 1.02–0.03, P = 0.03), and suPAR (OR = 1.37, 95% CI = 1.09–1.72, P = 0.007) were independently associated with CAD risk in young patients. Conclusions SuPAR is a novel independent risk factor for CAD in young Chinese patients. Further studies evaluating the effect of anti-inflammatory treatment on the suPAR levels and the risk of CAD are needed.
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Schernthaner C, Lichtenauer M, Wernly B, Paar V, Pistulli R, Rohm I, Jung C, Figulla HR, Yilmaz A, Cadamuro J, Haschke-Becher E, Pernow J, Schulze PC, Hoppe UC, Kretzschmar D. Multibiomarker analysis in patients with acute myocardial infarction. Eur J Clin Invest 2017; 47:638-648. [PMID: 28683166 DOI: 10.1111/eci.12785] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/04/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Novel biomarkers representing different pathobiological pathways and their role in patients with acute myocardial infarction (AMI) were studied. METHODS We retrospectively analysed serum levels of soluble suppression of tumorigenicity (sST2), growth-differentiation factor-15 (GDF-15), soluble urokinase plasminogen activator receptor (suPAR), heart-type fatty acid-binding protein (H-FABP) and plasma fetuin A in blood of patients with AMI (STEMI, n = 61; NSTEMI, n = 57) compared to controls with excluded coronary artery disease (n = 76). Furthermore, detailed correlation analysis was performed. RESULTS Compared with controls, in patients with STEMI and NSTEMI higher levels expressed as median of sST2 in pg/mL (STEMI: 13210·9, NSTEMI: 11989·1, control: 5248; P < 0·001), GDF-15 in pg/mL (STEMI: 818·8, NSTEMI 677·5, control 548·6; P < 0·001), suPAR in pg/mL (STEMI: 3461·1, NSTEMI: 3466·7, control: 2463·6; P < 0·001), H-FABP in ng/mL (STEMI: 5·8, NSTEMI: 5·4, control: 0·0; P < 0·001) and lower plasma fetuin A levels in μg/mL (STEMI: 95, NSTEMI: 54, control: 116·6; P < 0·001) were detected. Correlation analysis found clinical and biochemical parameters such as ejection fraction, length of hospital stay, creatine kinase, NT-proBNP and hs Troponin T levels as well as inflammatory markers (CRP, leucocytes) to be significantly correlated with novel biomarkers. CONCLUSION Plasma levels of novel biomarkers were significantly elevated (sST2, GDF-15, H-FABP, suPAR) or inversely downregulated (fetuin A) in patients with AMI compared to a control group with excluded coronary artery disease. Significant correlations with various clinical parameters and standard biochemical markers were found.
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Affiliation(s)
| | | | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Vera Paar
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Rudin Pistulli
- Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Department of Internal Medicine I, Friedrich-Schiller-University Jena, Jena, Germany
| | - Ilonka Rohm
- Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Department of Internal Medicine I, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Hans-Reiner Figulla
- Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Department of Internal Medicine I, Friedrich-Schiller-University Jena, Jena, Germany
| | - Attila Yilmaz
- Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Department of Internal Medicine I, Friedrich-Schiller-University Jena, Jena, Germany
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - John Pernow
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Schweden
| | - Paul Christian Schulze
- Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Department of Internal Medicine I, Friedrich-Schiller-University Jena, Jena, Germany
| | - Uta C Hoppe
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Daniel Kretzschmar
- Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Department of Internal Medicine I, Friedrich-Schiller-University Jena, Jena, Germany
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