Unchanged Plasma Levels of the Soluble Urokinase Plasminogen Activator Receptor in Elective Coronary Artery Bypass Graft Surgery Patients and Cardiopulmonary Bypass Use

Abstract

Objective and DesignThe soluble urokinase plasminogen activator receptor (suPAR) has been recently recognized as a potential biological marker of various disease states, but the impact of a major surgical intervention on the suPAR level has not yet been established. The aim of our study was to investigate if the induction of a systemic inflammatory reaction in response to cardiopulmonary bypass would be accompanied by an increase in the plasma suPAR level.Methods and SubjectsPatients undergoing coronary artery bypass grafting under cardiopulmonary bypass (CPB) were added. Based on the baseline suPAR level, patients were divided into group 1 (suPAR within normal range) or group 2 (suPAR above range). Blood was collected before the induction of anesthesia and 6 and 24 hours after surgery. Plasma suPAR, IL-6, IL-8, TNF-α, troponin I, NT-proBNP, and NGAL were quantified to assess the impact of surgical trauma on these markers.ResultsThe baseline suPAR level was within the normal range in 31 patients (3.3 ng/mL), and elevated in 29 (5.1 ng/mL) (p<0.001). Baseline mediators of systemic inflammatory reaction concentrations (IL-6, TNF-α, and IL-8) and organ injury indices (troponin I, NT-proBNP, and NGAL) were low and increased after surgery in all patients (p<0.05). The surgery did not cause significant changes in the suPAR level either at 6 or 24 hours after, however the difference between groups observed at baseline remained substantial during the postoperative period.ConclusionsThere was no change in the suPAR level observed in patients subjected to elective cardiac coronary artery bypass surgery and CPB, despite activation of a systemic inflammatory reaction.

Serum soluble urokinase‐type plasminogen activator receptor as a serum marker of inflammatory response that leads to tissue damage and surgical complication

“…During the early inflammatory response, serum suPAR levels remained low. This finding is in line with a recent study of suPAR in cardiac surgery . In that study, suPAR levels did not change as a result of surgical trauma, although a relationship between suPAR and biomarkers of tissue damage was found.…”

Soluble Urokinase-type Plasminogen Activator Receptor Predicts All-cause 5-Year Mortality in Ischemic Stroke and TIA

“…Interestingly, in a study of 60 patients undergoing coronary artery bypass surgery, perioperative levels of suPAR remained stable despite the extensive inflammatory reaction induced by such major surgery (37). Likewise, in patients with ST elevation MI undergoing primary percutaneous coronary angioplasty, suPAR levels remained unchanged even when hsCRP levels were considerably elevated (38).…”

Predicting Mortality in African Americans With Type 2 Diabetes Mellitus: Soluble Urokinase Plasminogen Activator Receptor, Coronary Artery Calcium, and High‐Sensitivity C‐Reactive Protein

“…Its membrane‐bound form, uPAR, is present in multiple cell types, including immunologically active cells and endothelial cells, and encompasses physiologic roles impacting the coagulation cascade through the plasminogen activating pathway, cell signaling through integrins, and cell motility . Although it may reflect immune activation, suPAR levels remain stable during episodes of sudden stress such as acute myocardial infarction or surgery; thus, suPAR differs from other inflammatory biomarkers such as hs‐CRP and interleukin‐6, which are acute‐phase reactants . SuPAR has been shown to scavenge vitronectin, a glycoprotein involved in coronary atherosclerosis .…”

“…35,36 Although it may reflect immune activation, suPAR levels remain stable during episodes of sudden stress such as acute myocardial infarction or surgery; thus, suPAR differs from other inflammatory biomarkers such as hs-CRP and interleukin-6, which are acute-phase reactants. 37,38 SuPAR has been shown to scavenge vitronectin, a glycoprotein involved in coronary atherosclerosis. 35 Asymmetric dimethylarginine, a marker of oxidative stress, has also been shown to correlate with suPAR levels 39 ; suPAR levels correlate with CAD risk factors and subclinical vascular dysfunction and can be modified by smoking cessation.…”