Can soluble urokinase plasminogen receptor predict outcomes after cardiac surgery?

Objectives: Soluble urokinase plasminogen activator receptor (suPAR) is abiomarker that has been implicated in several cardiac pathologies and has beenshown to be elevated in critically-ill populations. We measured plasma suPAR in a cohort of cardiac surgical patients to evaluate its ability to predict prolongedintensive care unit (ICU) and hospital length of stay and development ofcomplications following surgery. We compared suPAR against Euroscore II and CRP.Methods: Ninety patients undergoing cardiac surgery were recruited with samples taken preoperatively and on postoperative days 1, 2 and 3. suPAR was measured using enzyme-linked immunosorbent assay. Area under the receiver operating characteristic curve (AUROC) was used to test predictive capability of suPAR. Comparison was made with Euroscore II and C-reactive protein (CRP).Results: suPAR increased over time (p<0.001) with higher levels in patientsrequiring prolonged ICU and hospital stay, and prolonged ventilation (p<0.05).suPAR was predictive for prolonged ICU and hospital stay, and prolonged ventilation at all time-points (AUROC 0.66-0.74). Interestingly this association was also observed preoperatively, with preoperative suPAR predicting prolonged ICU (AUROC 0.66), and hospital stay (AUROC 0.67) and prolonged ventilation (AUROC 0.74). The predictive value of preoperative suPAR compared favourably to EuroSCORE II and CRP.Conclusions: suPAR increases following cardiac surgery and levels are higher inthose who require prolonged ICU stay, prolonged hospital stay and prolongedventilation. Preoperative suPAR compares favourably to EuroSCORE II and CRP inprediction of these outcomes. suPAR could be a useful biomarker in predictingoutcome following cardiac surgery, helping inform clinical decision making.