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Soluble urokinase plasminogen activator receptor (suPAR) levels predict damage accrual in patients with recent-onset systemic lupus erythematosus

Enocsson, Helena ; Wirestam, Lina LU ; Dahle, Charlotte ; Padyukov, Leonid ; Jönsen, Andreas LU ; Urowitz, Murray B. ; Gladman, Dafna D. ; Romero-Diaz, Juanita ; Bae, Sang Cheol and Fortin, Paul R. , et al. (2019) In Journal of Autoimmunity
Abstract

Objective: The soluble urokinase plasminogen activator receptor (suPAR) has potential as a prognosis and severity biomarker in several inflammatory and infectious diseases. In a previous cross-sectional study, suPAR levels were shown to reflect damage accrual in cases of systemic lupus erythematosus (SLE). Herein, we evaluated suPAR as a predictor of future organ damage in recent-onset SLE. Methods: Included were 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who met the 1997 American College of Rheumatology classification criteria with 5-years of follow-up data available. Baseline sera from patients and age- and sex-matched controls were assayed for suPAR. Organ damage was assessed... (More)

Objective: The soluble urokinase plasminogen activator receptor (suPAR) has potential as a prognosis and severity biomarker in several inflammatory and infectious diseases. In a previous cross-sectional study, suPAR levels were shown to reflect damage accrual in cases of systemic lupus erythematosus (SLE). Herein, we evaluated suPAR as a predictor of future organ damage in recent-onset SLE. Methods: Included were 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who met the 1997 American College of Rheumatology classification criteria with 5-years of follow-up data available. Baseline sera from patients and age- and sex-matched controls were assayed for suPAR. Organ damage was assessed annually using the SLICC/ACR damage index (SDI). Results: The levels of suPAR were higher in patients who accrued damage, particularly those with SDI≥2 at 5 years (N = 32, 46.8% increase, p = 0.004), as compared to patients without damage. Logistic regression analysis revealed a significant impact of suPAR on SDI outcome (SDI≥2; OR = 1.14; 95% CI 1.03–1.26), also after adjustment for confounding factors. In an optimized logistic regression to predict damage, suPAR persisted as a predictor, together with baseline disease activity (SLEDAI-2K), age, and non-Caucasian ethnicity (model AUC = 0.77). Dissecting SDI into organ systems revealed higher suPAR levels in patients who developed musculoskeletal damage (SDI≥1; p = 0.007). Conclusion: Prognostic biomarkers identify patients who are at risk of acquiring early damage and therefore need careful observation and targeted treatment strategies. Overall, suPAR constitutes an interesting biomarker for patient stratification and for identifying SLE patients who are at risk of acquiring organ damage during the first 5 years of disease.

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publication status
epub
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keywords
Biomarker, Organ damage, Outcome, Prognosis, SLE
in
Journal of Autoimmunity
publisher
Elsevier
external identifiers
  • scopus:85073722485
  • pmid:31629628
ISSN
0896-8411
DOI
10.1016/j.jaut.2019.102340
language
English
LU publication?
yes
id
1b1b8025-c7c5-4a73-93c8-df379947f105
date added to LUP
2019-11-12 10:59:42
date last changed
2019-11-25 09:35:40
@article{1b1b8025-c7c5-4a73-93c8-df379947f105,
  abstract     = {<p>Objective: The soluble urokinase plasminogen activator receptor (suPAR) has potential as a prognosis and severity biomarker in several inflammatory and infectious diseases. In a previous cross-sectional study, suPAR levels were shown to reflect damage accrual in cases of systemic lupus erythematosus (SLE). Herein, we evaluated suPAR as a predictor of future organ damage in recent-onset SLE. Methods: Included were 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who met the 1997 American College of Rheumatology classification criteria with 5-years of follow-up data available. Baseline sera from patients and age- and sex-matched controls were assayed for suPAR. Organ damage was assessed annually using the SLICC/ACR damage index (SDI). Results: The levels of suPAR were higher in patients who accrued damage, particularly those with SDI≥2 at 5 years (N = 32, 46.8% increase, p = 0.004), as compared to patients without damage. Logistic regression analysis revealed a significant impact of suPAR on SDI outcome (SDI≥2; OR = 1.14; 95% CI 1.03–1.26), also after adjustment for confounding factors. In an optimized logistic regression to predict damage, suPAR persisted as a predictor, together with baseline disease activity (SLEDAI-2K), age, and non-Caucasian ethnicity (model AUC = 0.77). Dissecting SDI into organ systems revealed higher suPAR levels in patients who developed musculoskeletal damage (SDI≥1; p = 0.007). Conclusion: Prognostic biomarkers identify patients who are at risk of acquiring early damage and therefore need careful observation and targeted treatment strategies. Overall, suPAR constitutes an interesting biomarker for patient stratification and for identifying SLE patients who are at risk of acquiring organ damage during the first 5 years of disease.</p>},
  author       = {Enocsson, Helena and Wirestam, Lina and Dahle, Charlotte and Padyukov, Leonid and Jönsen, Andreas and Urowitz, Murray B. and Gladman, Dafna D. and Romero-Diaz, Juanita and Bae, Sang Cheol and Fortin, Paul R. and Sanchez-Guerrero, Jorge and Clarke, Ann E. and Bernatsky, Sasha and Gordon, Caroline and Hanly, John G. and Wallace, Daniel J. and Isenberg, David A. and Rahman, Anisur and Merrill, Joan T. and Ginzler, Ellen and Alarcón, Graciela S. and Chatham, W. Winn and Petri, Michelle and Khamashta, Munther and Aranow, Cynthia and Mackay, Meggan and Dooley, Mary Anne and Manzi, Susan and Ramsey-Goldman, Rosalind and Nived, Ola and Steinsson, Kristjan and Zoma, Asad A. and Ruiz-Irastorza, Guillermo and Lim, S. Sam and Kalunian, Kenneth C. and Inanc, Murat and van Vollenhoven, Ronald F. and Ramos-Casals, Manuel and Kamen, Diane L. and Jacobsen, Søren and Peschken, Christine A. and Askanase, Anca and Stoll, Thomas and Bruce, Ian N. and Wetterö, Jonas and Sjöwall, Christopher},
  issn         = {0896-8411},
  language     = {eng},
  publisher    = {Elsevier},
  series       = {Journal of Autoimmunity},
  title        = {Soluble urokinase plasminogen activator receptor (suPAR) levels predict damage accrual in patients with recent-onset systemic lupus erythematosus},
  url          = {http://dx.doi.org/10.1016/j.jaut.2019.102340},
  doi          = {10.1016/j.jaut.2019.102340},
  year         = {2019},
}