Soluble Urokinase Receptor (SuPAR) in COVID-19-Related AKI
AKI commonly occurs in patients with coronavirus disease 2019 (COVID-19). Its pathogenesis is poorly understood. The urokinase receptor system is a key regulator of the intersection between inflammation, immunity, and coagulation, and soluble urokinase plasminogen activator receptor (suPAR) has been...
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| Published in: | Journal of the American Society of Nephrology Vol. 31; no. 11; pp. 2725 - 2735 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
American Society of Nephrology
01-11-2020
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | AKI commonly occurs in patients with coronavirus disease 2019 (COVID-19). Its pathogenesis is poorly understood. The urokinase receptor system is a key regulator of the intersection between inflammation, immunity, and coagulation, and soluble urokinase plasminogen activator receptor (suPAR) has been identified as an immunologic risk factor for AKI. Whether suPAR is associated with COVID-19-related AKI is unknown.
In a multinational observational study of adult patients hospitalized for COVID-19, we measured suPAR levels in plasma samples from 352 adult patients that had been collected within 48 hours of admission. We examined the association between suPAR levels and incident in-hospital AKI.
Of the 352 patients (57.4% were male, 13.9% were black, and mean age was 61 years), 91 (25.9%) developed AKI during their hospitalization, of whom 25 (27.4%) required dialysis. The median suPAR level was 5.61 ng/ml. AKI incidence rose with increasing suPAR tertiles, from a 6.0% incidence in patients with suPAR <4.60 ng/ml (first tertile) to a 45.8% incidence of AKI in patients with suPAR levels >6.86 ng/ml (third tertile). None of the patients with suPAR <4.60 ng/ml required dialysis during their hospitalization. In multivariable analysis, the highest suPAR tertile was associated with a 9.15-fold increase in the odds of AKI (95% confidence interval [95% CI], 3.64 to 22.93) and a 22.86-fold increase in the odds of requiring dialysis (95% CI, 2.77 to 188.75). The association was independent of inflammatory markers and persisted across subgroups.
Admission suPAR levels in patients hospitalized for COVID-19 are predictive of in-hospital AKI and the need for dialysis. SuPAR may be a key component of the pathophysiology of AKI in COVID-19. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 The following list includes the International Study of Inflammation in COVID-19: University of Michigan in Ann Arbor, Michigan: Salim S. Hayek, Pennelope Blakely, Hanna Berlin, Tariq U. Azam, Husam Shadid, Michael Pan, Patrick O’Hayer, Chelsea Meloche, Rafey Feroze, Kishan J. Padalia, Elizabeth Anderson, Danny Perry, Abbas Bitar, Rayan Kaakati, Lili Zhao, Peiyao Zhao; University of Copenhagen at Hvidovre Hospital, Denmark: Jesper Eugen-Olsen, Izzet Altintas, Jens Tingleff, Marius Stauning, Morten Baltzer Houlind, Mette B. Lindstrøm, Ove Andersen, Hejdi Gamst-Jensen, Line Jee Hartmann Rasmussen, Christian Rasmussen, Jan O. Nehlin, Thomas Kallemose, Imran Parvaiz; Attikon University Hospital in Athens, Greece: Evangelos J. Giamarellos-Bourboulis, Maria-Evangelia Adami, Nicky Solomonidi, Maria Tsilika, Maria Saridaki, Vasileios Lekakis; University Hospital Dusseldorf, Germany: Sven Loosen, Tom Luedde, Verena Keitel; University of Thessaly, Greece: Athanasios Chalkias, Eleni Arnaoutoglou, Ioannis Pantazopoulos, Eleni Laou, Konstantina Kolonia, Anargyros Skoulakis; Charité University Medicine Berlin, Germany: Frank Tacke, Pinkus Tober-Lau, Raphael Mohr, Florian Kurth, Leif Erik Sander, Christoph Jochum. First author listed is principle investigator. |
| ISSN: | 1046-6673 1533-3450 1533-3450 |
| DOI: | 10.1681/ASN.2020060829 |