title: Soluble urokinase plasminogen activator receptor as a prognostic marker of all-cause and cardiovascular mortality in a black population.
abstract: BACKGROUND
  Elevated inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) are well-known risk factors for cardiovascular mortality. The less familiar marker, soluble urokinase plasminogen activator receptor (suPAR), is known to predict cancer, infections and all-cause mortality. We determined whether suPAR, CRP and IL-6 are predictive of both all-cause and cardiovascular mortality in a black population, highly burdened by cardiovascular disease and HIV infection.
  
  
  METHODS
  We included 1425 black South Africans, of which 208 died within five years after baseline data collection. EDTA plasma biomarker levels were determined, while all-cause and cardiovascular mortality were used as endpoints.
  
  
  RESULTS
  At baseline suPAR, CRP and IL-6 were higher in non-survivors than in survivors (P<0.001). SuPAR (HR 1.27, 95% CI 1.09-1.48), IL-6 (HR 1.49, 95% CI 1.24-1.78) and CRP (HR 1.39, 95% CI 1.17-1.65) predicted all-cause mortality, while only suPAR (HR 1.40, 95% CI 1.04-1.87) and IL-6 (HR 1.61, 95% CI 1.10-2.35) predicted cardiovascular mortality. The prognostic value of suPAR was independent of IL-6 and CRP (P≤0.015).
  
  
  CONCLUSIONS
  SuPAR predicted both all-cause and cardiovascular mortality, independent of traditional risk factors, HIV and other inflammatory markers, underlining the prognostic value of suPAR in a black population.
authors.affiliation: Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa. Electronic address: shani.botha@nwu.ac.za.
authors.forename: Shani
authors.initials: S
authors.lastname: Botha
authors.affiliation: Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
authors.forename: Carla M T
authors.initials: CMT
authors.lastname: Fourie
authors.affiliation: Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; Medical Research Council, Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
authors.forename: Rudolph
authors.initials: R
authors.lastname: Schutte
authors.affiliation: Clinical Research Centre 136, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Eugen-Olsen
authors.affiliation: Research to Advance Quality of Nursing & Midwifery (INSINQ), North-West University, Potchefstroom, South Africa.
authors.forename: Ronel
authors.initials: R
authors.lastname: Pretorius
authors.affiliation: Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; Medical Research Council, Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
authors.forename: Aletta E
authors.initials: AE
authors.lastname: Schutte
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D044383:Black People / Q000208:ethnology*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000208:ethnology*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000208:ethnology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D013019:South Africa / Q000208:ethnology
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D055293:Receptors, Urokinase Plasminogen Activator
keywords: C-reactive protein; Death; Inflammation; Interleukin-6; Predict; South Africa