Soluble urokinase-type plasminogen activator receptor improves early risk stratification in cardiogenic shock
Status PubMed-not-MEDLINE Language English Country England, Great Britain Media print-electronic
Document type Journal Article
Grant support
Aarne Koskelo Foundation
the Finnish Cardiac Foundation
Department of Emergency Medicine
Services of Helsinki University Hospital
Aarne Koskelo Foundation
PubMed
35949144
PubMed Central
PMC9629697
DOI
10.1093/ehjacc/zuac096
PII: 6660742
Knihovny.cz E-resources
- Keywords
- Biomarker, Cardiogenic shock, Risk stratification, suPAR,
- Publication type
- Journal Article MeSH
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.
National Institute of Cardiology Warsaw Poland
Research Direction Consorci Sanitari Integral University of Barcelona Barcelona Spain
St Ann university hospital and Medical faculty Masaryk University Brno Czech Republic
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