Soluble urokinase plasminogen activator receptor (suPAR) levels predict damage accrual in patients with recent-onset systemic lupus erythematosus
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Date
2019-10-17Author
Enocsson, Helena
Wirestam, Lina
Dahle, Charlotte
Padyukov, Leonid
Jonsen, Andreas
Urowitz, Murray B
Gladman, Dafna D
Romero Díaz, Juanita
Bae, Sang Cheol
Fortin, Paul R.
Sánchez Guerrero, Jorge
Clarke, Ann E
Bernatsky, Sasha
Gordon, Caroline
Hanly, John G
Wallace, Daniel J.
Isenberg, David A
Rahman, Anisur
Merrill, Joan T
Ginzler, Ellen
Alarcón, Graciela S
Chatham, W Winn
Petri, Michelle
Khamashta, Munther
Aranow, Cynthia
Mackay, Meggan
Dooley, Mary Anne
Manzi, Susan
Ramsey Goldman, Rosalind
Nived, Ola
Steinsson, Kristjan
Zoma, Asad A
Ruiz Irastorza, Guillermo
Lim, S Sam
Kalunian, Kenneth C
Inanc, Murat
van Vollenhoven, Ronald F
Ramos Casals, Manuel
Kamen, Diane L
Jacobsen, Soren
Peschken, Christine A
Askanase, Anca
Stoll, Thomas
Bruce, Ian N
Wettero, Jonas
Sjowall, Christopher
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Journal of Autoimmunity 106 : (2019) // Article ID 102340
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.