Sat Aug 13 2022

Soluble Urokinase Plasminogen Activator Receptor and Venous Thromboembolism in COVID‐19

Conclusion

supar on thromboembolism Elevated levels of suPAR are linked to a higher risk of developing venous thromboembolism (VTE) in patients hospitalized due to COVID-19, even when considering the levels of D-dimer independently. By analyzing both suPAR and D-dimer together, healthcare professionals can effectively identify patients who are at a lower risk for VTE. This approach underscores the importance of incorporating multiple biomarkers to enhance risk stratification and potentially guide more personalized patient management strategies in the context of COVID-19.

Background

Venous thromboembolism (VTE) plays a major role in increasing both the morbidity and mortality associated with COVID-19. The urokinase receptor system, which plays a part in controlling coagulation, is linked to this process. The levels of suPAR serve as a marker for hyperinflammation and have shown a strong predictive value for patient outcomes in COVID-19 cases. However, it remains uncertain whether monitoring suPAR levels can effectively identify COVID-19 patients who are at a higher risk of developing VTE. This research area is vital for several reasons. First, understanding how suPAR levels relate to VTE risk can improve patient management. It allows for the identification of patients who might need more aggressive prevention strategies against blood clots. Additionally, it helps in deciding which patients should be monitored more closely for any signs of thrombosis.

Methods and Results

We leveraged a multinational observational study of patients hospitalized for COVID‐19 with suPAR and D‐dimer levels measured on admission. In 1960 patients (mean age, 58 years; 57% men; 20% Black race), we assessed the association between suPAR and incident venous thromboembolism (VTE) (defined as pulmonary embolism or deep vein thrombosis) using logistic regression and Fine‐Gray modeling, accounting for the competing risk of death. VTE occurred in 163 (8%) patients and was associated with higher suPAR and D‐dimer levels. There was a positive association between suPAR and D‐dimer (β=7.34; P=0.002). Adjusted for clinical covariables, including D‐dimer, the odds of VTE were 168% higher comparing the third with first suPAR tertiles (adjusted odds ratio, 2.68 [95% CI, 1.51–4.75]; P<0.001). Findings were consistent when stratified by D‐dimer levels and in survival analysis accounting for death as a competing risk. On the basis of predicted probabilities from random forest, a decision tree found the combined D‐dimer <1 mg/L and suPAR <11 ng/mL cutoffs, identifying 41% of patients with only 3.6% VTE probability.

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