The Plasma Soluble Urokinase Plasminogen Activator Receptor Is Related to Disease Activity of Patients with ANCA-Associated Vasculitis

Abstract

Objective. The soluble urokinase plasminogen activator receptor (suPAR) is associated with kidney diseases and is used as a prognostic factor of renal function progression. The aim of this study was to explore whether circulating suPAR was associated with antineutrophil cytoplasmic autoantibody- (ANCA-) associated vasculitis (AAV) disease activity. Methods. We evaluated 90 AAV patients with follow-up data and 35 normal controls; their plasma suPAR and C-reactive protein (CRP) levels were measured by ELISA. Associations between these levels, clinical parameters, and prognosis were analyzed. Results. Plasma suPAR levels in AAV patients were significantly higher than in healthy controls (5,920.08±3,447.17 vs. 1,441.97±835.04 pg/mL, P<0.001). Furthermore, suPAR was significantly elevated in AAV patients in active stage compared to those in partial remissions (6,492.19±3,689.48 vs. 5,031.86±2,489.01 pg/mL, P=0.039). Correlation analyses demonstrated that suPAR levels positively correlated with initial serum creatinine, BVAS, CRP, and procalcitonin concentration, and negatively correlated with eGFR and C3 circulating levels. In a Kaplan-Meier survival analysis, patients with plasma suPAR levels >5683.3 pg/mL showed poorer survival than patients with lower levels (log-rank, P=0.001). Besides, multivariate analyses confirmed that plasma suPAR levels were an independent adverse prognostic factor for a composite outcome of end-stage renal disease (ESRD) or death, after adjusting for age and gender (HR 1.05, 95% CI=1.01−1.11, P=0.043). Receiver operating characteristic curves showed a suPAR cutoff value >6662.2 pg/mL for composite outcome with 68% sensitivity and 88% specificity, with an AUC=0.82, (95% CI=0.68−0.96, P<0.001). Conclusion. Circulating suPAR levels might be a marker of activity correlated with disease activity in AAV patients, and, to some extent, could be a factor of poor prognosis.

Evaluation of Plasma Urokinase-Type Plasminogen Activator Receptor and Interleukin 34 in Patients with Chronic Hepatitis C as Serological Fibrosis Markers

“…While, there was no correlation of sUPAR with age or sex of the patients. This was in line with Huang et al, who did not find any correlation of sUPAR with age or gender of patients with HCV with hepatic fibrosis [10].…”

“…It has been found that sUPAR has an important role in inflammation, proteolysis and tissue remodeling. Accordingly, sUPAR level is strongly elevated in acute liver failure and advanced chronic liver diseases, especially in decompensated cirrhosis, indicating that hepatic inflammation in principle is linked to hepatic UPAR expression and sUPAR release [10].…”

Soluble Urokinase Plasminogen Activator Receptor (suPAR) in Autoimmune Rheumatic and Non Rheumatic Diseases

“…SuPAR levels in 90 AAV patients were assessed, and it was found that they were significantly higher than in HC patients. Additionally, suPAR was found to be significantly higher in AAV patients who were in active stages of the disease compared to those who were in partial remission, indicating a link between disease activity and a poor prognosis [45]. Similar findings were found in another study by Rowaiye et al where 60 patients with renal involvement and AAV have been followed up for a median period of 12 months with higher levels of suPAR in patients with relapse compared with patients with inactive AAV.…”

Immune Cells Profiling in ANCA-Associated Vasculitis Patients—Relation to Disease Activity

“…In a number of studies, it has been suggested that the suPAR level reflects the activation state of the immune system [ 42 , 43 , 44 , 45 ]. There are a few studies suggesting that the suPAR plasma level can be considered a biomarker in AAV as well [ 78 ]. The results of our study confirm that an elevated level of the suPAR is associated with the AAV disease, and that its increased level is related to AAV-related deterioration of the kidney function.…”