Soluble urokinase plasminogen activator receptor and survival in elective cardiac surgery

Background: The study investigated the prognostic value of soluble urokinase plasminogen activator receptor (suPAR) in patients undergoing cardiac surgery and calculated a simplified biomarker score comprising suPAR, N-terminal pro B -type natriuretic peptide (NT-proBNP) and age.Methods and Results: Biomarkers were assessed in a cohort of 478 patients undergoing elective cardiac surgery. After a median follow -up of 4.2 years, a total of 72 (15.1%) patients died. SuPAR, NTproBNP and age were independent prognosticators of mortality in a multivariable Cox regression model after adjustment for EuroScoreII. We then calculated a simplified biomarker score comprising age, suPAR and NTproBNP, which had a superior prognostic value compared to EuroScoreII (Harrel's C of 0.76 vs. 0.72; P for difference = 0.02). Besides long -term mortality, the biomarker score had an excellent performance predicting one -year mortality and hospitalization due to heart failure.Conclusion: The biomarker suPAR and NTproBNP were strongly and independently associated with mortality in patients undergoing cardiac surgery. A simplified biomarker score comprising only three variables (age, suPAR and NTproBNP) performed better than the established EuroScoreII with respect to intermediate and long -term outcome as well as hospitalization due to heart failure. As such, integration of established and upcoming biomarkers in clinical practice may provide improved decision support in cardiac surgery.