SuPAR predicts 10-year mortality in HIV infected and hypertensive black South Africans

Abstract

Objective: Soluble urokinase plasminogen activator receptor (suPAR), a more reliable inflammatory marker than C-reactive protein (CRP), predicts risk of cancer and diabetes in the general population. We determined whether suPAR predicts mortality in a black population, double burdened by hypertension and HIV infection. Methods: We included 1862 black South Africans from the Prospective Urban and Rural Epidemiology study. Plasma suPAR was determined with the suPARnostic® ELISA Kit, high-sensitivity CRP with the Konelab20iTM auto-analyzer, HIV with the First Response rapid HIV card test and blood pressure with the OMRON HEM-757 device. Results: At baseline, participants had a median age of 48 (range: 29-94) years, 38.3% were male, 16.4% were HIV infected and 47.0% were hypertensive. Over the 10-year follow-up (median 5.3±1.1 years), 331 participants died. Baseline suPAR and CRP were higher in non-survivors than in survivors (all p<0.001) and predicted mortality (suPAR: HR 1.27; 95%CI 1.15-1.40; log-rank p<0.001 and CRP: HR 1.35; 95%CI 1.20-1.53; log-rank p<0.001) in the total group (Fig. 1 and 2). Similarly, the HIV infected group (n=306), suPAR and CRP were higher (all p<0.001) in non-survivors than in survivors and predicted mortality (suPAR: HR 1.44; 95%CI 1.13-1.84 and CRP: HR 1.45; 95%CI 1.16-1.82). However, in the hypertensive group (n=876), only suPAR was higher (p<0.001) in non-survivors than in survivors and predicted mortality (HR 1.32; 95%CI 1.12-1.54). Conclusions: Our results identify suPAR as a prognostic marker of 10-year mortality risk in the presence of HIV infection and hypertension. This warrants further investigation into using suPAR to improve disease outcome in black South Africans