Clinical value of soluble urokinase-type plasminogen activator receptor in predicting sepsis-associated acute kidney injury

Abstract

Background

Sepsis-associated acute kidney injury (S-AKI) is a critical illness and is often associated with high morbidity and mortality rates. The soluble urokinase-type plasminogen activator receptor (suPAR) is an important immune mediator and is involved in kidney injury. However, its diagnostic value in S-AKI patients remains unclear. Therefore, we assessed the early predictive value of suPAR for S-AKI patients.

Methods

We prospectively enrolled adult patients, immediately after fulfilling the sepsis-3 criteria. Plasma suPAR levels at 0-, 12-, 24-, and 48-h post-sepsis diagnosis were measured. S-AKI development was the primary outcome. S-AKI risk factors were analyzed using logistic regression, and the value of plasma suPAR for early S-AKI diagnosis was assessed using receiver operating characteristic (ROC) curves.

Results

Of 179 sepsis patients, 63 (35.2%) developed AKI during hospitalization. At 12-, 24-, and 48-h post-sepsis diagnosis, plasma suPAR levels were significantly higher in patients with S-AKI than in patients without S-AKI (p < 0.05). The plasma suPAR had the highest area under the ROC curve of 0.700 (95% confidence interval (CI), 0.621–0.779) at 24-h post-sepsis diagnosis, at which the best discrimination ability for S-AKI was achieved with suPAR of ≥6.31 ng/mL (sensitivity 61.9% and specificity 71.6%). Logistic regression analysis showed that suPAR at 24-h post-sepsis diagnosis remained an independent S-AKI risk factor after adjusting for mechanical ventilation, blood urea nitrogen, and pH.

Conclusions

The findings suggest that plasma suPAR may be a potential biomarker for early S-AKI diagnosis.

Keywords:

• Acute kidney injury
• ICU
• sepsis
• soluble urokinase-type plasminogen activator receptor

Acknowledgments

We want to thank all the co-authors of this study. This research was not published as a preprint. A portion of the study’s findings were presented at the 60th ERA Congress Abstracts in June 2023 with the title ‘Clinical Value of Soluble Urokinase-Type Plasminogen Activator Receptor in Diagnosis and Prognosis of Sepsis-Associated Acute Kidney Injury’, Link: ttps://doi.org/10.1093/ndt/gfad063c_3644.

Ethics approval

The study protocol was approved by the Ethics Committee of Henan Provincial People’s Hospital (approval number: 2023-Lunshen-47) and informed consent was obtained from the patient or the patient’s representative.

Authors’ contributions

W.Z., F.S., and Y.G. conceived and designed the study. W.Z. and J.Z. performed the experiment. Sample collection, data collection, and analysis are performed by W.Z., J.W. X.Z., X.D., H.L.,L.Y., and X.J. Manuscript preparation and revision was done by W.Z.,Y.G. and F.S. All authors revised and approved the final manuscript and are accountable for the accuracy and integrity of the work.

Disclosure statement

The authors declared no potential conflict of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

This work was supported by the funding of Zhongyuan Scholars of Henan Provincial Health Commission under Grant [number 224000510005], the Henan Province Science and Technology Attack Plan Project under Grant [number 222102310429 and 212102310201], Zhongyuan Scholar Workstation under Grant [number 234400510024], and the National Natural Science Foundation of China under Grant [number 81770725].