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D R, Johnson P, Das S, Gr S. Serum Soluble Urokinase-Type Plasminogen Activator Receptor: A Promising Biomarker for Stable Chronic Obstructive Pulmonary Disease Patients. Cureus 2025; 17:e79594. [PMID: 40151757 PMCID: PMC11947502 DOI: 10.7759/cureus.79594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2025] [Indexed: 03/29/2025] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a condition in which airflow limitation becomes irreversible over time, often resulting from long-term exposure to environmental pollutants, harmful particles, smoke, and biomass fuel. Beyond FEV1, identifying a more specific biomarker to predict COPD progression remains a challenge. Soluble urokinase-type plasminogen activator receptor (suPAR) expression increases in the respiratory epithelial cells of COPD patients. This study aimed to evaluate serum suPAR levels across different grades of stable COPD patients. Methods Two hundred stable COPD patients (148 males and 52 females) were recruited after obtaining informed consent. Blood samples were collected, and serum suPAR levels were measured in all participants. Results Serum suPAR levels were elevated in COPD patients at Global Initiative for Obstructive Lung Disease (GOLD) stages IV and III (6.38 ± 0.05 ng/ml and 5.82 ± 0.18 ng/ml, respectively) compared to those at GOLD stages II and I (5.15 ± 0.25 ng/ml and 4.17 ± 0.29 ng/ml). A one-way ANOVA confirmed that the differences between groups were statistically significant (F = 428.83, p < 0.001). Conclusions This study suggests that serum suPAR levels can serve as a diagnostic marker for COPD. As low-grade pulmonary inflammation increases with disease severity, suPAR levels also rise. Additionally, this marker may be useful for monitoring the prognosis of stable COPD and assessing treatment response.
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Affiliation(s)
- Rekha D
- Physiology, Pondicherry Institute of Medical Sciences, Puducherry, IND
| | - Priscilla Johnson
- Physiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Subhasis Das
- Physiology, Pondicherry Institute of Medical Sciences, Puducherry, IND
| | - Sathya Gr
- Physiology, Pondicherry Institute of Medical Sciences, Puducherry, IND
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2
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Akdeniz YS, Özkan S. New markers in chronic obstructive pulmonary disease. Adv Clin Chem 2024; 123:1-63. [PMID: 39181619 DOI: 10.1016/bs.acc.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Chronic obstructive pulmonary disease (COPD), a global healthcare and socioeconomic burden, is a multifaceted respiratory disorder that results in substantial decline in health status and life quality. Acute exacerbations of the disease contribute significantly to increased morbidity and mortality. Consequently, the identification of reliable and effective biomarkers for rapid diagnosis, prediction, and prognosis of exacerbations is imperative. In addition, biomarkers play a crucial role in monitoring responses to therapeutic interventions and exploring innovative treatment strategies. Although established markers such as CRP, fibrinogen and neutrophil count are routinely used, a universal marker is lacking. Fortunately, an increasing number of studies based on next generation analytics have explored potential biomarkers in COPD. Here we review those advances and the need for standardized validation studies in the appropriate clinical setting.
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Affiliation(s)
- Yonca Senem Akdeniz
- Department of Emergency Medicine, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Türkiye.
| | - Seda Özkan
- Department of Emergency Medicine, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
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3
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Zhang Y, Hong S, Zhang Q, Su Z, Hu G, Wang T, Yu S, Yuan F, Zhu X, Jia G. Relationship between systemic inflammation and lung injury induced by chromate exposure: A cross-sectional study in workers. JOURNAL OF HAZARDOUS MATERIALS 2023; 452:131294. [PMID: 37023571 DOI: 10.1016/j.jhazmat.2023.131294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 05/03/2023]
Abstract
Hexavalent chromium [Cr(VI)] compounds, known as "Group I Human Carcinogen" and "Category I Respiratory Sensitizer", posed great challenges to the respiratory system. A cross-sectional study was undertaken among chromate workers. Serum club cell protein 16 (CC16) and soluble urokinase-type plasminogen activator receptor (suPAR) were measured using ELISA. Thirteen macrophage-related mediators were tested using cytometric bead array. After controlling for sex, age, smoking status, drinking status and BMI, each increase of one-unit of Ln-transformed blood Cr was related to the increase of IL-1beta [Beta (95% CI), 7.22(1.14, 13.29)%, P = 0.021], IL-23 [8.5(1.15, 15.85)%, P = 0.021], IFN-gamma [3.14(0.15, 6.13)%, P = 0.040], and suPAR [9.31(2.5, 16.12) %, P = 0.008], as well as the increase of CC16 by 3.88(0.42, 7.34) % (P = 0.029). Moreover, these inflammatory mediators played an mediation role in the rise of CC16 caused by Cr(VI). The exposure-response curve analysis revealed a substantial nonlinear association of IFN-gamma and suPAR with CC16, thus the mediation effect of INF-gamma and suPAR required cautious interpretation. The positive connection between macrophage-related mediators was stronger in the high exposure group than in the low exposure group, suggesting that high concentration of chromate might promote a complex interplay within the immune system.
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Affiliation(s)
- Yali Zhang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100083, China
| | - Shiyi Hong
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100083, China
| | - Qiaojian Zhang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100083, China
| | - Zekang Su
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100083, China
| | - Guiping Hu
- School of Engineering Medicine and Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100083, China.
| | - Tiancheng Wang
- Department of Clinical Laboratory, Third Hospital of Peking University, Beijing 100083, China
| | - Shanfa Yu
- Henan Institute for Occupational Medicine, Zhengzhou City, Henan Province 450052, China
| | - Fang Yuan
- Department of Occupational Health and Radiological Health, Chongqing Center for Disease Control and Prevention, Chongqing 400042, China
| | - Xiaojun Zhu
- National Center for Occupational Safety and Health, Beijing 102308, China
| | - Guang Jia
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100083, China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100083, China.
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4
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Kotsiou OS, Pantazopoulos I, Mavrovounis G, Marsitopoulos K, Tourlakopoulos K, Kirgou P, Daniil Z, Gourgoulianis KI. Serum Levels of Urokinase Plasminogen Activator Receptor (suPAR) Discriminate Moderate Uncontrolled from Severe Asthma. J Pers Med 2022; 12:jpm12111776. [PMID: 36579490 PMCID: PMC9693242 DOI: 10.3390/jpm12111776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The most clinically useful concept in asthma is based on the intensity of treatment required to achieve good asthma control. Biomarkers to guide therapy are needed. AIMS To investigate the role of circulating levels of soluble urokinase plasminogen activator receptor suPAR as a marker for asthma severity. METHODS We recruited patients evaluated at the Asthma Clinic, University of Thessaly, Greece. Asthma severity and control were defined according to the GINA strategy and Asthma Contro Test (ACT). Anthropometrics, spirometry, fractional exhaled nitric oxide (FeNO), suPAR, blood cell count, c-reactive protein (CRP), and analyses of kidney and liver function were obtained. Patients with a history of inflammatory, infectious, or malignant disease or other lung disease, more than 5 pack years of smoking history, or corticosteroid therapy were excluded. RESULTS We evaluated 74 asthma patients (69% female, mean age 57 ± 17 years, mean body mass index (BMI) 29 ± 6 kg/m2). In total, 24%, 13%, 6%, 5%, 29% and 23% of the participants had mild well-controlled, mild uncontrolled, moderate well-controlled, moderate uncontrolled, severe well-controlled, and severe uncontrolled asthma, respectively. Overall, 67% had T2-high asthma, 26% received biologics (15% and 85% received omalizumab and mepolizumab, respectively), and 34% had persistent airway obstruction. suPAR levels were significantly lower in asthmatics with moderate uncontrolled asthma than in patients with severe uncontrolled asthma without (2.1 ± 0.4 vs. 3.3 ± 0.7 ng/mL, p = 0.023) or with biologics (2.1 ± 0.4 vs. 3.6 ± 0.8 ng/mL, p = 0.029). No correlations were found between suPAR levels and age, BMI, T2 biomarkers, CRP, or spirometric parameters. CONCLUSIONS suPAR levels were higher in asthmatics with severe disease than in those with moderate uncontrolled asthma.
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Affiliation(s)
- Ourania S. Kotsiou
- Department of Human Pathophysiology, Faculty of Nursing, University of Thessaly, 41110 Larissa, Greece
- Correspondence:
| | | | - Georgios Mavrovounis
- Department of Respiratory Medicine, University of Thessaly, 41500 Larissa, Greece
| | | | | | - Paraskevi Kirgou
- Department of Respiratory Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Zoe Daniil
- Department of Respiratory Medicine, University of Thessaly, 41500 Larissa, Greece
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5
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Egervall K, Rosso A, Elmståhl S. Association between cardiovascular disease- and inflammation-related serum biomarkers and poor lung function in elderly. Clin Proteomics 2021; 18:23. [PMID: 34583636 PMCID: PMC8480099 DOI: 10.1186/s12014-021-09329-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a common comorbidity in chronic obstructive pulmonary disease (COPD) and reduced lung function is an important risk factor for CVD and CVD-related death. However, the mechanisms behind the increased risk for CVD in COPD patients are not fully understood. Methods We examined the association between CVD- and inflammation-related serum biomarkers, and pulmonary function in a geriatric population. 266 biomarkers related to CVD and inflammation were analyzed in blood samples from 611 subjects aged 66–86 years who participated in the Good Aging in Skåne study. Serum levels were assessed by a proximity extension assay. Pulmonary function was measured using the lower limit of normality (LLN) spirometry criteria, i.e., forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < LLN. Logistic regression models were implemented and multiple comparisons were accounted for. Results 10.3% of the study participants fulfilled pulmonary function decline criteria according to LLN. Out of the 266 biomarkers, only plasminogen activator, urokinase receptor (PLAUR) was statistically significantly associated with decreased pulmonary function. We could not find a statistically significant association between pulmonary function decline and other biomarkers previously linked to COPD, such as interleukin 6, tumor necrosis factor and surfactant protein D. Conclusion We found that serum levels of PLAUR are associated with pulmonary function decline in older adults. PLAUR is activated following inflammation and promotes matrix metallopeptidase (MMP) activation and extracellular matrix (ECM) degradation. This implies that PLAUR could play a role in the early phase of COPD pathogenesis. Supplementary Information The online version contains supplementary material available at 10.1186/s12014-021-09329-7.
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Affiliation(s)
- K Egervall
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
| | - A Rosso
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - S Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
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6
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Eleven genomic loci affect plasma levels of chronic inflammation marker soluble urokinase-type plasminogen activator receptor. Commun Biol 2021; 4:655. [PMID: 34079037 PMCID: PMC8172928 DOI: 10.1038/s42003-021-02144-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Soluble urokinase-type plasminogen activator receptor (suPAR) is a chronic inflammation marker associated with the development of a range of diseases, including cancer and cardiovascular disease. The genetics of suPAR remain unexplored but may shed light on the biology of the marker and its connection to outcomes. We report a heritability estimate of 60% for the variation in suPAR and performed a genome-wide association meta-analysis on suPAR levels measured in Iceland (N = 35,559) and in Denmark (N = 12,177). We identified 13 independently genome-wide significant sequence variants associated with suPAR across 11 distinct loci. Associated variants were found in and around genes encoding uPAR (PLAUR), its ligand uPA (PLAU), the kidney-disease-associated gene PLA2R1 as well as genes with relations to glycosylation, glycoprotein biosynthesis, and the immune response. These findings provide new insight into the causes of variation in suPAR plasma levels, which may clarify suPAR's potential role in associated diseases, as well as the underlying mechanisms that give suPAR its prognostic value as a unique marker of chronic inflammation.
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7
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Fibrinogen is a promising biomarker for chronic obstructive pulmonary disease: evidence from a meta-analysis. Biosci Rep 2021; 40:225825. [PMID: 32677669 PMCID: PMC7383837 DOI: 10.1042/bsr20193542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 02/08/2023] Open
Abstract
Backgrounds: Some studies have reported association of circulating fibrinogen with the risk of chronic obstructive pulmonary disease (COPD), and the results are conflicting. To yield more information, we aimed to test the hypothesis that circulating fibrinogen is a promising biomarker for COPD by a meta-analysis. Methods: Data extraction and quality assessment were independently completed by two authors. Effect-size estimates are expressed as weighted mean difference (WMD) with 95% confidence interval (95% CI). Results: Forty-five articles involving 5586/18604 COPD patients/controls were incorporated. Overall analyses revealed significantly higher concentrations of circulating fibrinogen in COPD patients than in controls (WMD: 84.67 mg/dl; 95% CI: 64.24–105.10). Subgroup analyses by COPD course showed that the degree of increased circulating fibrinogen in patients with acute exacerbations of COPD (AECOPD) relative to controls (WMD: 182.59 mg/dl; 95% CI: 115.93–249.25) tripled when compared in patients with stable COPD (WMD: 56.12 mg/dl; 95% CI: 34.56–77.67). By COPD severity, there was a graded increase in fibrinogen with the increased severity of COPD relative to controls (Global Initiative for Obstructive Lung Disease (GOLD) I, II, III, and IV: WMD: 13.91, 29.19, 56.81, and 197.42 mg/dl; 95% CI: 7.70–20.11, 17.43–40.94, 39.20–74.41, and −7.88 to 402.73, respectively). There was a low probability of publication bias. Conclusion: Our findings indicate a graded, concentration-dependent, significant relation between higher circulating fibrinogen and more severity of COPD.
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8
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Sever ZK, Bircan HA, Sirin FB, Evrimler S, Celik S, Merd N. Serum biomarkers in patients with stable and exacerbated COPD-bronchiectasis overlap syndrome. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:1032-1039. [PMID: 32750728 DOI: 10.1111/crj.13238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Bronchiectasis (B), commonly seen in patients with chronic obstructive pulmonary disease (COPD), is associated with exacerbations and predicts mortality. OBJECTIVES To differentiate patient groups with COPD-(B+) or COPD-(B-) and their exacerbations by using inflammatory markers. METHODS Consecutive COPD patients were divided into two groups according to findings on high resolution thorax CT (HRCT) images using Smith and modified Reiff scores. Patients were prospectively followed for possible future exacerbations. Serum fibrinogen, C-reactive protein (CRP), soluble urokinase-type plasminogen activator receptor (suPAR) and Plasminogen activator inhibitor-1 (PAI-1) levels were studied during exacerbation and stable periods. RESULTS Eighty-seven patients were included and (85 M, 2 F), mean aged was 68.1 ± 9 (46-87). HRCT confirmed bronchiectasis in 38 (43.7%) patients, most commonly in tubular form (89.4%) and in lower lobes. COPD-B(+) group had lower body mass index (P = 0.036), more advanced stage of disease (P = 0.004) and more frequent exacerbation (P = 0.01). The HRCT scores were correlated with exacerbation rate (r = 0.356, P < 0.05). Fibrinogen and CRP values were higher in exacerbation (P = 0.01, P = 0.013, respectively) especially in COPD-B(+) patients. suPAR and PAI-1 levels were also higher in COPD-B(+) patients although it was not statistically significant. CONCLUSION Bronchiectasis is common and causes frequent exacerbations in COPD. Identifying of COPD-B(+) phenotype by HRCT scoring systems has considerable importance for both therapeutic options and clinical outcome of the disease. In addition to fibrinogen and CRP, high serum levels of suPAR and PAI-1 suggest us their significant roles in increased systemic inflammation associated with coexisting of COPD and bronchiectasis.
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Affiliation(s)
- Zekiye Kula Sever
- Department of Pulmonary Medicine, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Haci Ahmet Bircan
- Department of Pulmonary Medicine, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Fevziye Burcu Sirin
- Department of Biochemistry, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Sehnaz Evrimler
- Department of Radiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Seda Celik
- Department of Biochemistry, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Neslihan Merd
- Department of Radiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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9
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Huang Q, Xiong H, Shuai T, Wang Y, Zhang C, Zhang M, Zhu L, Lu J, Liu J. The clinical value of suPAR in diagnosis and prediction for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Ther Adv Respir Dis 2020; 14:1753466620938546. [PMID: 32643535 PMCID: PMC7350130 DOI: 10.1177/1753466620938546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Soluble urokinase-type plasminogen activator receptor (suPAR) is positively correlated with immune system activity. Inflammation can promote the development of chronic obstructive pulmonary disease (COPD). Therefore, this study conducted a systematic review and meta-analysis to assess the association between suPAR levels and the pathogenesis of COPD, and further assess the exact clinical value of suPAR in COPD. METHODS PubMed, Excerpt Medica Database (Embase), Web of Science (WOS), and Cochrane Library databases were searched for studies that reported the value of suPAR diagnosis for adult COPD patients. RESULTS A total of 11 studies were included, involving 4520 participants. Both COPD patients with predicted forced expiratory volume in 1 s (FEV1)⩾80% [weighted mean difference (WMD) = 320.25; 95% confidence interval (CI): 99.79-540.71] and FEV1 < 80% (WMD = 2950.74; 95% CI: 2647.06-3254.43) showed higher suPAR level. The sensitivity and specificity of suPAR for diagnosis of COPD were 87% and 79%, respectively, and AUC was 84%. This can not only effectively identify acute exacerbation of COPD (AECOPD) in a healthy population (WMD = 3114.77; 95% CI: 2814.66-3414.88), but also has the potential to distinguish AECOPD from stable COPD (WMD = 351.40; 95% CI: 215.88-486.93). There was a significant decrease of suPAR level after treatment [WMD = -1226.97; 95% CI: -1380.91- (-1073.03)]. CONCLUSION suPAR as a novel biomarker has potential for early diagnosis of COPD and prediction of AECOPD. There is a potential correlation between the level of suPAR and the state of COPD, which may also indicate the early state and severity of COPD. When the suPAR level of COPD patients is further increased, the risk of acute exacerbation increases and should be highly valued. This also shows potential as a measure of treatment response, and as a guide to the clinical management in COPD. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Qiangru Huang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Huaiyu Xiong
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Tiankui Shuai
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Yalei Wang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Chuchu Zhang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Meng Zhang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Lei Zhu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Jiaju Lu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Jian Liu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China.,The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
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10
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Håkansson KEJ, Ulrik CS, Godtfredsen NS, Kallemose T, Andersen O, Eugen-Olsen J, Marsaa K, Rasmussen LJH. High suPAR and Low Blood Eosinophil Count are Risk Factors for Hospital Readmission and Mortality in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:733-743. [PMID: 32308381 PMCID: PMC7147624 DOI: 10.2147/copd.s229904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/21/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction The biomarker soluble urokinase plasminogen activator receptor (suPAR) has been associated with increased mortality in chronic obstructive pulmonary disease (COPD), while elevated blood eosinophils have been associated with better survival. We hypothesized that suPAR and blood eosinophil count are independent risk factors for readmission and mortality after an acute admission in patients with COPD. Methods This retrospective cohort study comprised 4022 patients with prevalent COPD acutely admitted to Hvidovre Hospital, Denmark. Irrespective of cause of admission, suPAR and blood eosinophils were measured, and patients were followed up to 365 days. Associations with 365-day respiratory readmission, all-cause readmission and all-cause mortality were investigated by Cox regression analyses adjusted for age, sex, Charlson score and C-reactive protein. Results suPAR was significantly elevated in patients who later experienced readmission or died. At 365 days, hazard ratios (HRs) for all-cause readmission and mortality reached 1.61 (95% CI 1.40–1.85; p<0.0001) and 3.40 (95% CI 2.64–4.39; p<0.0001), respectively, for COPD patients in the fourth suPAR quartile compared to patients in the first suPAR quartile. High blood eosinophils (>300 cells/μL) were associated with lower risk of mortality (HR 0.49, 95% CI 0.39–0.62; p<0.0001) compared with patients with <150 cells/μL. When stratifying patients by suPAR quartiles and blood eosinophil counts, the highest relative mortality rate was found in patients belonging to both the fourth suPAR quartile and the low blood eosinophil (<150 cells/μL) group. Conclusion In this cohort of COPD patients acutely admitted to a hospital, elevated suPAR concentrations were associated with both higher risk of all-cause readmission and mortality, whereas higher blood eosinophil count was associated with lower risk of mortality.
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Affiliation(s)
- Kjell E J Håkansson
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Charlotte S Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina S Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kallemose
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Kristoffer Marsaa
- Palliative Unit, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Line J H Rasmussen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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11
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Böcskei RM, Benczúr B, Losonczy G, Illyés M, Cziráki A, Müller V, Bohács A, Bikov A. Soluble Urokinase-Type Plasminogen Activator Receptor and Arterial Stiffness in Patients with COPD. Lung 2019; 197:189-197. [PMID: 30820636 PMCID: PMC6486892 DOI: 10.1007/s00408-019-00211-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/18/2019] [Indexed: 02/01/2023]
Abstract
Introduction Soluble urokinase-type plasminogen activator receptor (suPAR) is upregulated by inflammation and plays a role in the pathogenesis of atherosclerosis. Chronic obstructive pulmonary disease (COPD) is associated with enhanced systemic inflammation and increased risk for atherosclerosis, however, studies analysing the circulating suPAR levels in COPD are contradictory. The aim of the study was to investigate plasma suPAR concentrations together with markers of arterial stiffness in COPD. Materials and Methods Twenty-four patients with COPD and 18 non-COPD, control subjects participated in the study. Plasma suPAR was measured, together with lung volumes, symptom burden, exacerbation history, markers of arterial stiffness and soluble inflammatory biomarkers, such as endothelin-1, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6). Results Plasma suPAR levels were higher in COPD (2.84 ± 0.67 ng/ml vs. 2.41 ± 0.57 ng/ml, p = 0.03) and were related to lung function measured with FEV1 (r = − 0.65, p < 0.01) and symptom burden determined with the modified Medical Research Council questionnaire (r = 0.55, p < 0.05). Plasma suPAR concentrations correlated with various measures of arterial stiffness in all subjects, but only with ejection duration in COPD (r = − 0.44, p = 0.03). Conclusions Plasma suPAR levels are elevated in COPD and relate to arterial stiffness. Our results suggest that suPAR may be a potential link between COPD and atherosclerosis.
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Affiliation(s)
- Renáta M Böcskei
- Department of Pulmonology, Semmelweis University, Diós árok Street. 1/c, Budapest, 1125, Hungary.
| | - Béla Benczúr
- 1st Dept of Internal Medicine (Cardiology/Nephrology), Balassa Janos County Hospital, Béri Balogh Ádám Street 5-7, Szekszárd, 7100, Hungary
| | - György Losonczy
- Department of Pulmonology, Semmelweis University, Diós árok Street. 1/c, Budapest, 1125, Hungary
| | - Miklós Illyés
- Heart Institute, Faculty of Medicine, University of Pécs, Ifjúság Street 13, Pecs, 7624, Hungary
| | - Attila Cziráki
- Heart Institute, Faculty of Medicine, University of Pécs, Ifjúság Street 13, Pecs, 7624, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Diós árok Street. 1/c, Budapest, 1125, Hungary
| | - Anikó Bohács
- Department of Pulmonology, Semmelweis University, Diós árok Street. 1/c, Budapest, 1125, Hungary
| | - András Bikov
- Department of Pulmonology, Semmelweis University, Diós árok Street. 1/c, Budapest, 1125, Hungary
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12
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AboEl-Magd GH, Mabrouk MM. Soluble urokinase-type plasminogen activator receptor as a measure of treatment response in acute exacerbation of COPD. ACTA ACUST UNITED AC 2019. [PMID: 29538541 PMCID: PMC6104538 DOI: 10.1590/s1806-37562017000000151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: To evaluate the value of soluble urokinase-type plasminogen activator receptor (suPAR) in the diagnosis of acute exacerbation of COPD (AECOPD) and in monitoring treatment response, analyzing the relationship between suPAR and fibrinogen in AECOPD. AECOPD leads to increased airway inflammation, contributing to an exaggerated release of inflammatory mediators. Methods: We recruited 45 patients with AECOPD and 20 healthy control subjects. Medical histories were taken, and all subjects underwent clinical examination, chest X-ray, pulmonary function tests, and blood gas analysis. On day 1 (treatment initiation for the AECOPD patients) and day 14 (end of treatment), blood samples were collected for the determination of serum suPAR and plasma fibrinogen. Results: Serum levels of suPAR were significantly higher in the AECOPD group than in the control group. In the AECOPD patients, there was a significant post-treatment decrease in the mean serum suPAR level. The sensitivity, specificity, and accuracy of suPAR were 95.6%, 80.0%, and 93.0%, respectively. The Global Initiative for Chronic Obstructive Lung Disease stage (i.e., COPD severity) correlated positively and significantly with serum levels of suPAR and plasma levels of fibrinogen. Conclusions: Monitoring the serum suPAR level can be helpful in the evaluation of the COPD treatment response and might be a valuable biomarker for determining the prognosis of AECOPD. Because serum suPAR correlated with plasma fibrinogen, both markers could be predictive of AECOPD.
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Affiliation(s)
| | - Maaly Mohamed Mabrouk
- . Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
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13
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Godtfredsen NS, Jørgensen DV, Marsaa K, Ulrik CS, Andersen O, Eugen-Olsen J, Rasmussen LJH. Soluble urokinase plasminogen activator receptor predicts mortality in exacerbated COPD. Respir Res 2018; 19:97. [PMID: 29783959 PMCID: PMC5963104 DOI: 10.1186/s12931-018-0803-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/02/2018] [Indexed: 01/26/2023] Open
Abstract
Background 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. 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. Methods This 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. Results For 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. Conclusions In 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. Electronic supplementary material The online version of this article (10.1186/s12931-018-0803-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nina S Godtfredsen
- Department of Pulmonary Medicine, Amager and Hvidovre University Hospital, Hvidovre, Denmark. .,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Ditte V Jørgensen
- Department of Pulmonary Medicine, Amager and Hvidovre University Hospital, Hvidovre, Denmark
| | - Kristoffer Marsaa
- Palliative Unit, Gentofte and Herlev University Hospital, Herlev, Denmark
| | - Charlotte S Ulrik
- Department of Pulmonary Medicine, Amager and Hvidovre University Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Clinical Research Center, Amager and Hvidovre University Hospital, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Center, Amager and Hvidovre University Hospital, Hvidovre, Denmark
| | - Line J H Rasmussen
- Clinical Research Center, Amager and Hvidovre University Hospital, Hvidovre, Denmark
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14
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Desmedt S, Desmedt V, Delanghe JR, Speeckaert R, Speeckaert MM. The intriguing role of soluble urokinase receptor in inflammatory diseases. Crit Rev Clin Lab Sci 2017; 54:117-133. [DOI: 10.1080/10408363.2016.1269310] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - J. R. Delanghe
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
| | - R. Speeckaert
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
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15
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Liu X, Shen Y, Li Z, Fei A, Wang H, Ge Q, Pan S. Prognostic significance of APACHE II score and plasma suPAR in Chinese patients with sepsis: a prospective observational study. BMC Anesthesiol 2016; 16:46. [PMID: 27473112 PMCID: PMC4966698 DOI: 10.1186/s12871-016-0212-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/15/2016] [Indexed: 12/22/2022] Open
Abstract
Background Timely risk stratification is the key strategy to improve prognosis of patients with sepsis. Previous study has proposed to develop a powerful risk assessment rule by the combination of Acute Physiology and Chronic Health Evaluation II (APACHE II) score and plasma soluble urokinase plasminogen activator receptor (suPAR). That reaffirmation of suPAR as a prognostic marker in Chinese patients with severe sepsis is the aim of the study. Methods A total of 137 consecutive Chinese patients with sepsis were enrolled in a prospective study cohort. Demographic and clinical characteristics, conventional risk factors and important laboratory data were prospectively recorded. Sequential plasma suPAR concentrations were measured by an enzymeimmunoabsorbent assay on days 1, 3, and 7 after admission to the intensive care unit (ICU). Receiver operating characteristic (ROC) curves and Cox regression analysis were used to examine the performance of suPAR in developing a rule for risk stratification. Results The results showed that plasma suPAR concentrations remained relatively stable within survivors and non-survivors during the first week of disease course. Regression analysis indicated that APACHE II ≥15 and suPAR ≥10.82 ng/mL were independently associated with unfavorable outcome. With the above cutoffs of APACHE II and suPAR, strata of disease severity were determined. The mortality of each stratum differed significantly from the others. Conclusions Combination of APACHE II score and suPAR may supply the powerful prognostic utility for the mortality of sepsis.
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Affiliation(s)
- Xuan Liu
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yong Shen
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Zhihua Li
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Aihua Fei
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Hairong Wang
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Qinmin Ge
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Shuming Pan
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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