SuPAR, a new prognostic marker in acute heart failure with reduced ejection fraction?
A Bollas Becerra, M Cortes Garcia, J Lumpuy-Castillo, C S Garcia-Talavera, M B Arroyo Rivera, L De Miguel Garcia, J M Romero Otero, J A Esteban Chapel, M Taibo-Urquia, A M Pello Lazaro, M L Gonzalez-Casaus, I Mahillo-Fernandez, O Lorenzo Gonzalez, J Tunon FernandezAbstract
Abstract
Introduction and objectives: new biomarkers are arising in the context of heart failure, although their prognostic value is still to be fully clarified. We aim to highlight the value of soluble urokinase receptor suPAR, involved in the plasminogen activation cascade, inflammation and cell scarring. Our aim was to analyze the prognostic value of suPAR with regards to the risk of death from any cause and heart failure hospitalization in patients with decompensated heart failure with reduced ejection fraction (HFrEF).
Methods
a prospective, single-center study was conducted, including 104 patients with decompensated HFrEF. At admission, serum and plasma samples were collected and biomarkers, including suPAR, were analyzed. A univariate Cox regression analysis was performe
d to identify the association with all-cause mortality and rehospitalization for HF, and diagnostic accuracy was evaluated using ROC curves.
Results
A total of 104 patients (78% male, mean age 66.7 years) with a mean LVEF of 21% and treated with the drugs listed in the table were included. After a median follow-up of 23.5 months, there were 21 readmissions for HF and 20 deaths from any cause. suPAR was significantly associated with new hospitalization for HF (HR 1.41 [95% CI 1.12-1.77]) and all-cause mortality (HR 1.49 [95% CI 1.24-1.79]). Plotting ROC curves (figure), the AUCs for rehospitalization and mortality were 0.61 (95% CI 0.52-0.71) and 0.70 (95% CI 0.61-0.79), which was significantly higher than the AUC of NT-proBNP for hospitalization (p=0.006) but not for mortality (p=0.61). Analyzing the ROC curves, 7.84 ng/mL is proposed for a PPV of 100% and NPV of 83% for mortality, and 10.2 ng/mL for a PPV of 100% and NPV of 81% for new hospitalization, assuming an incidence of 20% for both endpoints.
Conclusions
suPAR showed acceptable prognostic value for rehospitalization due to HF and death from any cause in patients with decompensated HFpEF, significantly outperforming NT-proBNP in terms of hospitalization but not mortality. The high positive predictive values with acceptable negative predictive values are noteworthy, although larger studies will be necessary to validate these findings and define the role of suPAR in different patient subgroups.ROC curves for mortality and hospFor image description, please refer to the figure legend and surrounding text.