Prognostic value of supar and hs-crp on postoperative mortality following on-pump cardiac surgery

Introduction Elevated levels of soluble urokinase-type plasminogen activating receptor (suPAR) and high-sensitivity C-Reactive Protein (hs-CRP) have in previous studies been associated with increased mortality in selected cardiac surgery populations1 2. Aim of this study was to explore the relationship between suPAR and hsCRP-values and mortality in 30 days and during 1st year from surgery in patients admitted for elective cardiac surgery. Further, to assess whether a combined risk model of EuroSCORE II, suPAR and/or hs-CRP would improve the prognostic accuracy compared to EuroSCORE II alone. Methods Adult patients admitted for elective on-pump cardiac surgery, from August 2012 to June 2018, were included (n=931). Biobank blood samples were analysed for suPAR and hs-CRP levels. Biomarkers and clinical data were explored in relation to quartiles of the two biomarkers. Kaplan-Meier and Cox proportional hazard analysis were used to explore any association between preoperative suPAR and hs-CRP-values and all-cause mortality up to 1-year after surgery. Thirty-day mortality was predicted from suPAR, hsCRP and EuroSCORE II by logistic regression and compared using area under the ROC curve and Brier scores. Results A doubling of suPAR and hsCRP corresponded to a hazard ratio (HR) for all-cause mortality of 2.27 (95% CI 1.65-3.11, p Discussion In conclusion, elevated levels of the proinflammatory biomarkers, suPAR and hs-CRP, can be used as preoperative risk assessment for all-cause mortality in a population of all-comers to elective on-pump cardiac surgery. However, combination of either or both biomarkers to EuroSCORE II did not improve the prognostic accuracy compared to EuroSCORE II alone. In future studies, preoperative assessment of proinflammatory biomarkers may be used to establish personalised rehabilitation programs and follow-up on high-risk patients.