Soluble urokinase plasminogen activator receptor (suPAR): Its relation to neurological outcome in patients with survived cardiac arrest

Background: High serum levels of the inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) have been associated with poor neurological outcome in patients after cardiac arrest (CA), but with inadequate and contradictive prediction values. The purpose of this study was to provide further evidence on the prognostic value of suPAR for the prediction of poor neurological outcome after initially survived CA. Methods: A total of 177 patients were prospectively enrolled in this cohort study. 85 patients with survived CA were included and the neurological outcome was assessed after 6 months. 71 patients with ST-segmental elevation myocardial infarction (STEMI) and 21 healthy control patients served as comparative groups. Results: The serum suPAR levels on admission and the subsequent serum course were significantly higher in patients with CA as compared to STEMI and control patients. Furthermore, patients with poor neurological outcome showed significantly higher serum suPAR levels as compared to patients with good neurological outcome. By the use of ROC-curves and setting the specificities to 100%, inadequate sensitivities and cut-off values were calculated (day 2: sensitivity 21.1%, cut-off 10.2 ng/dl, AUC 0.716). By setting the specificities to at least 80% the best prediction values could be calculated for day 2 with a sensitivity of 57.9% and a cut-off value of 5.3 ng/dl. Conclusions: SuPAR serum levels in patients with poor neurological outcome were significantly higher as compared to patients with good neurological outcome. However, the prognostic value was low and inadequate because of a substantial overlap of serum suPAR levels between the outcome groups