Soluble urokinase plasminogen activator receptor predicts mortality in exacerbated COPD

Nina S Godtfredsen,Ove Andersen,Kristoffer Marsaa,Line J H Rasmussen,Ditte V Jørgensen,Charlotte S Ulrik,Jesper Eugen-Olsen

doi:10.1186/s12931-018-0803-2

Abstract

BackgroundThe inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) is elevated in severe acute and chronic medical conditions and has been associated with short-term mortality. The role of suPAR in predicting risk of death following an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has never been studied. We hypothesized that increased suPAR is an independent predictor of short-term mortality in patients admitted to hospital with COPD or acute respiratory failure.MethodsThis retrospective cohort study from a university hospital in the Capital Region of Denmark included 2838 acutely admitted medical patients with COPD as primary (AECOPD) or secondary diagnosis, who had plasma suPAR measured at the time of admission between November 18th, 2013 to September 30th, 2015 and followed until December 31st, 2015. Primary outcomes were 30- and 90-days all-cause mortality. Association of suPAR and mortality was investigated by Cox regression analyses adjusted for age, sex, CRP values and Charlson comorbidity index.ResultsFor patients with AECOPD or underlying COPD, median suPAR levels were significantly higher among patients who died within 30 days compared with those who survived (5.7 ng/ml (IQR 3.8–8.1) vs. 3.6 ng/ml (2.7–5.1), P < 0.0001). Increasing suPAR levels independently predicted 30-day mortality in patients with COPD with a hazard ratio of 2.0 (95% CI 1.7–2.4) but not respiratory failure.ConclusionsIn this large group of acutely admitted patients with COPD, elevated suPAR levels were associated with increased risk of mortality. The study supports the value of suPAR as a marker of poor prognosis.

Highlights

The inflammatory biomarker soluble urokinase plasminogen activator receptor is elevated in severe acute and chronic medical conditions and has been associated with short-term mortality
High soluble urokinase plasminogen activator receptor (suPAR) and CRP are associated with increased risk of mortality In all groups, except for patients admitted with Respiratory failure by 30 days of follow-up, median suPAR levels were significantly higher among those who died within 30 or 90 days of follow-up compared with patients who survived (Table 2)
We showed that median suPAR levels were higher among those who died within 90 days of admission compared with those who survived in all three groups of respiratory patients

Summary

Introduction

The inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) is elevated in severe acute and chronic medical conditions and has been associated with short-term mortality. We hypothesized that increased suPAR is an independent predictor of short-term mortality in patients admitted to hospital with COPD or acute respiratory failure. In many patients with COPD, the course of the disease will be progressive with a gradual decline in health status and increasing frequency and severity of acute exacerbations (AECOPD). In the ECLIPSE cohort, Godtfredsen et al Respiratory Research (2018) 19:97 previous exacerbations, older age, high white blood cell count, emphysema, severe airflow limitation and poor health status were associated with increased risk of future hospitalizations [4]. A readmission and mortality risk prediction score, comprising previous admissions, extended dyspnoea grade, age and heart failure but no biomarkers, has been proposed [7]

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