Prevalence and prognostic value of elevated soluble urokinase plasminogen activator receptor (suPAR) in patients admitted with acute heart failure

BACKGROUND: The inflammatory biomarker, soluble urokinase plasminogen activator receptor (suPAR), has emerged as a promising prognostic biomarker in cardiovascular diseases. However, little is known about suPAR levels in patients admitted with acute heart failure (AHF). This study investigates the prevalence and prognostic value of elevated suPAR in patients hospitalized with AHF. METHODS: This cohort study included patients presenting with cardiopulmonary symptoms at the Medical Emergency Department of University Hospital Amager-Hvidovre, Denmark, between March 10, 2020, and March 31, 2022. SuPAR was measured upon admission, with the median time from admission to measurement of two hours (IQR 3.9 - 6.9). A cardiologist adjudicated whether the patients had AHF. Patients were stratified according to validated cut-off values of suPAR <6 ng/ml and ≥ 6 ng/ml. Kaplan-Meier survival analysis and Cox regression were used to assess the association between suPAR levels and one-year mortality. RESULTS: A total of 386 (3.8%) AHF patients, from a total population of 10,027, were included. The mean suPAR value was significantly higher among AHF patients compared to non-AHF patients: 6.2 ng/ml (standard deviation [SD] = 4.8 ng/ml) vs 4.4 ng/ml (SD = 2.9 ng/ml), p < 0.001. A suPAR level ≥ 6 ng/ml was significantly associated with mortality, log-rank-p-value <0.0001. Furthermore, Cox regression analysis demonstrated that elevated suPAR levels were independently associated with increased risk of mortality with a hazard ratio (HR): 1.06 (95% CI: 1.03-1.1, p < 0.001) after adjusting for potential confounders. CONCLUSION: SuPAR levels measured at hospital admission in AHF patients correlate significantly with one-year mortality and outperform C-reactive protein, supporting their potential role in early prognostication to identify high-risk patients.