Conclusion

SuPAR is linked with mortality and offers better risk prediction in cardiovascular syndrome (CS) patients, beyond traditional risk factors. This highlights its value as a powerful biomarker for assessing patient risk more accurately.

Aims

The soluble urokinase-type plasminogen activator receptor (suPAR) serves as a biomarker that indicates the degree of immune system activation. Research has demonstrated its prognostic significance across various medical conditions, including acute coronary syndrome, heart failure, and critical illnesses. Given the intricate mechanisms underlying cardiogenic shock (CS), it was theorized that suPAR could also offer prognostic insight in this context. The purpose of our study was to examine the behavior and prognostic relevance of suPAR levels in patients experiencing cardiogenic shock. We aimed to understand how suPAR levels change over time in CS patients and to evaluate whether these levels could predict outcomes, thereby providing valuable information for clinical decision-making in the management of cardiogenic shock.

Methods and results

In the CardShock study, an observational multicentre project, researchers measured suPAR levels in plasma samples (0–96 hours) from 161 CS patients. They explored how suPAR levels change over time, their link to 90-day mortality, and their role in improving risk stratification. The study found the median baseline suPAR level was 4.4 ng/mL (interquartile range 3.2–6.6). Higher suPAR levels, above the median, correlated with comorbidities, markers of renal and cardiac dysfunction, and increased 90-day mortality (49% vs. 31%, P = 0.02). At every time point, survivors had significantly lower suPAR levels than nonsurvivors. For risk stratification, suPAR levels at 12 hours (suPAR12h) with a cut-off of 4.4 ng/mL independently predicted mortality, showing a strong association (odds ratio 5.6, 95% confidence interval 2.0–15.5, P = 0.001). Incorporating suPAR12h > 4.4 ng/mL into the CardShock risk score enhanced its ability to identify high-risk patients previously considered at intermediate risk.