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

Research output: Contribution to journalArticle

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 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.

Details

Authors
  • Helena Enocsson
  • Charlotte Dahle
  • Leonid Padyukov
  • Murray B. Urowitz
  • Dafna D. Gladman
  • Juanita Romero-Diaz
  • Sang Cheol Bae
  • Paul R. Fortin
  • Jorge Sanchez-Guerrero
  • Ann E. Clarke
  • Sasha Bernatsky
  • Caroline Gordon
  • John G. Hanly
  • Daniel J. Wallace
  • David A. Isenberg
  • Anisur Rahman
  • Joan T. Merrill
  • Ellen Ginzler
  • Graciela S. Alarcón
  • W. Winn Chatham
  • Michelle Petri
  • Munther Khamashta
  • Cynthia Aranow
  • Meggan Mackay
  • Mary Anne Dooley
  • Susan Manzi
  • Rosalind Ramsey-Goldman
  • Kristjan Steinsson
  • Asad A. Zoma
  • Guillermo Ruiz-Irastorza
  • S. Sam Lim
  • Kenneth C. Kalunian
  • Murat Inanc
  • Ronald F. van Vollenhoven
  • Manuel Ramos-Casals
  • Diane L. Kamen
  • Søren Jacobsen
  • Christine A. Peschken
  • Anca Askanase
  • Thomas Stoll
  • Ian N. Bruce
  • Jonas Wetterö
  • Christopher Sjöwall
Organisations
External organisations
  • Linköping University
  • Karolinska University Hospital
  • University of Toronto
  • Salvador Zubirán National Institute of Health Sciences and Nutrition
  • Hanyang University
  • Laval University
  • University of Calgary
  • McGill University Health Center
  • University of Birmingham
  • Dalhousie University
  • University of California, Los Angeles
  • University College London
  • Oklahoma Medical Research Foundation
  • State University of New York Downstate Medical Center
  • University of Alabama
  • Johns Hopkins University School of Medicine
  • Feinstein Institute for Medical Research
  • University of North Carolina
  • Allegheny Health Network
  • Northwestern University Feinberg School of Medicine
  • National University Hospital of Iceland
  • Hairmyres Hospital
  • University of the Basque Country
  • Emory University
  • University of California, San Diego
  • Academic Medical Center of University of Amsterdam (AMC)
  • Chinese University of Hong Kong
  • Hospital Clínic of Barcelona
  • Medical University of South Carolina
  • Copenhagen University Hospital
  • University of Manitoba
  • Columbia University
  • Bern University Hospital
  • University of Manchester
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Rheumatology and Autoimmunity

Keywords

  • Biomarker, Organ damage, Outcome, Prognosis, SLE
Original languageEnglish
Article number102340
JournalJournal of Autoimmunity
Volume106
Early online date2019
Publication statusPublished - 2020
Publication categoryResearch
Peer-reviewedYes