suPAR Combined With NT-proBNP and HEART Score Achieves 99% Negative Predictive Value in Chest Pain
In a multicentre study of 198 emergency department patients presenting with chest pain, soluble urokinase plasminogen activator receptor above 3.3 ng/mL independently predicted 30-day adverse events with an AUC of 0.78. When combined with NT-proBNP and the HEART score, the triple-negative rule-out strategy achieved a 99% negative predictive value. The findings position suPAR as a complementary ED biomarker for early risk stratification in suspected acute coronary syndrome.
The original study
Prognostic value of soluble urokinase plasminogen activator receptor in patients presenting to the emergency department with chest pain suggestive of acute coronary syndrome.
- Authors
- Chenevier-Gobeaux C, Lemarechal H, Doumenc B, Peschanski N, Claessens YE, Borderie D, et al.
- Journal
- Clinical biochemistry
- Type
- Evaluation Study, Journal Article, Multicenter Study
- PMID
- 33662350
Original abstract
INTRODUCTION: Soluble urokinase plasminogen activator receptor (suPAR) is a prognostic biomarker of cardiovascular disease. OBJECTIVES: We aimed to evaluate the early prognostic value of suPAR in patients presenting to the emergency department (ED) with chest pain suggestive of acute coronary syndrome (ACS). PATIENTS AND METHODS: In a post-hoc analysis from a multicenter study including patients with a chest pain < 6 h, suPAR concentrations at ED admission were studied according to the outcome at 30-days. RESULTS: 198 patients (median age 56 years) in whom 16% had an ACS, were included. Fifteen (7.3%) patients presented a 30-day event. At ED admission, median (IQR) suPAR concentrations were higher in patients with a 30-day event in comparison to patients without event (4.54 (3.09-8.61) vs. 2.72 (2.10-3.43) ng/mL, p < 0.001). The ROC curve AUC of suPAR for the prediction of a 30-days event was 0.775 [95%CI: 0.710-0.831]. The optimal threshold was 3.3 ng/mL, with a sensitivity of 73 [45-92] % and a specificity of 72 [65-79] %. The association of a suPAR < 3.3 ng/mL AND a NT-proBNP < 160 ng/L AND a HEART score < 4 had a negative predictive value of 99 [91-100] %. A suPAR value at admission above 3.3 ng/mL was independently and significantly associated with a 30-day event in chest pain emergency patients (OR 4.87 [1.35-17.51], p = 0.015). CONCLUSION: suPAR is a promising biomarker for early prediction of events in chest pain emergency patients.