SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis
Gethin W Hodges, Casper N Bang, Jesper Eugen-Olsen, Michael H Olsen, Kurt Boman, Simon Ray, Antero Y Kesäniemi, Jørgen L Jeppesen, Kristian Wachtell, Gethin W Hodges, Casper N Bang, Jesper Eugen-Olsen, Michael H Olsen, Kurt Boman, Simon Ray, Antero Y Kesäniemi, Jørgen L Jeppesen, Kristian Wachtell
Abstract
Background: We evaluated whether early measurement of soluble urokinase plasminogen activator receptor (suPAR) could predict future risk of postoperative complications in initially asymptomatic patients with mild-moderate aortic stenosis (AS) undergoing aortic valve replacement (AVR) surgery.
Methods: Baseline plasma suPAR levels were available in 411 patients who underwent AVR surgery during follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Cox analyses were used to evaluate suPAR in relation to all-cause mortality and the composite endpoint of postoperative complications (all-cause mortality, congestive heart failure, stroke and renal impairment) occurring in the 30-day postoperative period.
Results: Patients with initially higher levels of suPAR were at increased risk of postoperative mortality with a HR of 3.5 (95% CI 1.4 to 9.0, P=0.008) and postoperative complications with a HR of 2.7 (95% CI 1.5 to 5.1, P=0.002), per doubling in suPAR. After adjusting for the European System for Cardiac Operative Risk Evaluation or Society of Thoracic Surgeons risk score, suPAR remained associated with postoperative mortality with a HR 3.2 (95% CI 1.2 to 8.6, P=0.025) and 2.7 (95% CI 1.0 to 7.8, P=0.061); and postoperative complications with a HR of 2.5 (95% CI 1.3 to 5.0, P=0.007) and 2.4 (95% CI 1.2 to 4.8, P=0.011), respectively.
Conclusion: Higher baseline suPAR levels are associated with an increased risk for postoperative complications and mortality in patients with mild-moderate, asymptomatic AS undergoing later AVR surgery. Further validation in other subsets of AS individuals are warranted.
Trial registration number: NCT00092677; Post-results.
Keywords: aortic valve disease; inflammation; surgery-valve.
Conflict of interest statement
Competing interests: JEO is a co-founder and shareholder of ViroGates A⁄S, Denmark, the company that produces the suPARnostic assay. He is a co-inventor on patents on suPAR and risk. Copenhagen University Hospital Hvidovre, Denmark, owns the patents, which are licensed to ViroGates A⁄S. KB, SR, AYK and KW served on the SEAS Steering Committee were investigators and members of the steering committees of the SEAS study and have received honoraria from Merck & Co, the sponsor of the SEAS study. KB, SR and KW have received grant support from Merck & Co, the sponsor of the SEAS study. AYK reported Speaker’s fee from Abbott, MSD and Novo Nordisk, Consult for MSD, research funding from MSD and ownership of Orion Pharma stock.
References
- Hodges GW, Bang CN, Wachtell K, et al. . suPAR: a new biomarker for cardiovascular disease? Can J Cardiol 2015;31:1293–302. 10.1016/j.cjca.2015.03.023
- Hayek SS, Koh KH, Grams ME, et al. . A tripartite complex of suPAR, APOL1 risk variants and αvβ3 integrin on podocytes mediates chronic kidney disease. Nat Med 2017;23:945–53. 10.1038/nm.4362
- Hayek SS, Sever S, Ko YA, et al. . Soluble urokinase receptor and chronic kidney disease. N Engl J Med 2015;373:1916–25. 10.1056/NEJMoa1506362
- Zimmermann HW, Koch A, Seidler S, et al. . Circulating soluble urokinase plasminogen activator is elevated in patients with chronic liver disease, discriminates stage and aetiology of cirrhosis and predicts prognosis. Liver Int 2012;32:500–9. 10.1111/j.1478-3231.2011.02665.x
- Hodges GW, Bang CN, Eugen-Olsen J, et al. . SuPAR predicts cardiovascular events and mortality in patients with asymptomatic aortic stenosis. Can J Cardiol 2016;32:1462–9. 10.1016/j.cjca.2016.04.012
- Mossanen JC, Pracht J, Jansen TU, et al. . Elevated soluble urokinase plasminogen activator receptor and proenkephalin serum levels predict the development of acute kidney injury after cardiac surgery. Int J Mol Sci 2017;18:1662 10.3390/ijms18081662
- Brown ML, Pellikka PA, Schaff HV, et al. . The benefits of early valve replacement in asymptomatic patients with severe aortic stenosis. J Thorac Cardiovasc Surg 2008;135:308–15. 10.1016/j.jtcvs.2007.08.058
- Rosenhek R, Iung B, Tornos P, et al. . ESC working group on valvular heart disease position paper: assessing the risk of interventions in patients with valvular heart disease. Eur Heart J 2012;33:822–8. 10.1093/eurheartj/ehr061
- Nashef SA, Roques F, Sharples LD, et al. . EuroSCORE II. Eur J Cardiothorac Surg 2012;41:734–45. 10.1093/ejcts/ezs043
- O’Brien SM, Shahian DM, Filardo G, et al. . The society of thoracic surgeons 2008 cardiac surgery risk models: part 2 – isolated valve surgery. Ann Thorac Surg 2009;88:S23–S42. 10.1016/j.athoracsur.2009.05.056
- Shahian DM, O’Brien SM, Filardo G, et al. . The society of thoracic surgeons 2008 cardiac surgery risk models: part 3 – valve plus coronary artery bypass grafting surgery. Ann Thorac Surg 2009;88:S43–S62. 10.1016/j.athoracsur.2009.05.055
- Monin JL, Lancellotti P, Monchi M, et al. . Risk score for predicting outcome in patients with asymptomatic aortic stenosis. Circulation 2009;120:e75–75. 10.1161/CIRCULATIONAHA.108.808857
- Holme I, Pedersen TR, Boman K, et al. . A risk score for predicting mortality in patients with asymptomatic mild to moderate aortic stenosis. Heart 2012;98:377–83. 10.1136/heartjnl-2011-300475
- Lindman BR, Breyley JG, Schilling JD, et al. . Prognostic utility of novel biomarkers of cardiovascular stress in patients with aortic stenosis undergoing valve replacement. Heart 2015;101:1382–8. 10.1136/heartjnl-2015-307742
- Rossebø AB, Pedersen TR, Allen C, et al. . Design and baseline characteristics of the simvastatin and ezetimibe in aortic stenosis (SEAS) study. Am J Cardiol 2007;99:970–3. 10.1016/j.amjcard.2006.10.064
- Andersen O, Eugen-Olsen J, Kofoed K, et al. . Soluble urokinase plasminogen activator receptor is a marker of dysmetabolism in HIV-infected patients receiving highly active antiretroviral therapy. J Med Virol 2008;80:209–16. 10.1002/jmv.21114
- Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th edn Boston, Massachusetts: Little, Brown & Co, 1994:253–6.
- Peev V, Hahm E, Reiser J. Unwinding focal segmental glomerulosclerosis. F1000Res 2017;6:466 10.12688/f1000research.10510.1
- Gallon L, Quaggin SE, SuPAR QSE. SuPAR and FSGS: is the jury still out? Nat Rev Nephrol 2017;13:593 10.1038/nrneph.2017.109
- Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, et al. . Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 2013;382:339–52. 10.1016/S0140-6736(13)60595-4
- Borthwick E, Ferguson A. Perioperative acute kidney injury: risk factors, recognition, management, and outcomes. BMJ 2010;341:c3365 10.1136/bmj.c3365
- Thunø M, Macho B, Eugen-Olsen J. suPAR: the molecular crystal ball. Dis Markers 2009;27:157–72. 10.1155/2009/504294
- Eugen-Olsen J, Andersen O, Linneberg A, et al. . Circulating soluble urokinase plasminogen activator receptor predicts cancer, cardiovascular disease, diabetes and mortality in the general population. J Intern Med 2010;268:296–308. 10.1111/j.1365-2796.2010.02252.x
- Eapen DJ, Manocha P, Ghasemzadeh N, et al. . Soluble urokinase plasminogen activator receptor level is an independent predictor of the presence and severity of coronary artery disease and of future adverse events. J Am Heart Assoc 2014;3:e001118 10.1161/JAHA.114.001118
- Westaby S, De Silva R, Petrou M, et al. . Surgeon-specific mortality data disguise wider failings in delivery of safe surgical services. Eur J Cardiothorac Surg 2015;47:341–5. 10.1093/ejcts/ezu380
Source: PubMed