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Licensed Unlicensed Requires Authentication Published by De Gruyter February 4, 2021

Long term pronostic value of suPAR in chronic heart failure: reclassification of patients with low MAGGIC score

Anne Marie Dupuy, Nils Kuster, Anne Sophie Bargnoux, Sylvain Aguilhon, Fabien Huet, Florence Leclercq, Jean-Luc Pasquié, François Roubille and Jean Paul Cristol



Inflammation is a hallmark of heart failure (HF) and among inflammatory biomarkers, the most studied remains the C-reactive protein (CRP). In recent years several biomarkers have emerged, such as sST2 and soluble urokinase–type plasminogen activator receptor (suPAR). This study set out to examine the relative importance of long-time prognostic strength of suPAR and the potential additive information on patient risk with chronic HF in comparison with pronostic value of CRP and sST2.


Demographics, clinical and biological variables were assessed in a total of 182 patients with chronic HF over median follow-up period of 80 months. Inflammatory biomarkers (i.e., CRP, sST2, and suPAR) were performed.


In univariate Cox regression analysis age, NYHA class, MAGGIC score and the five biomarkers (N-terminal pro brain natriuretic peptide [NT-proBNP], high-sensitive cardiac troponin T [hs-cTnT], CRP, sST2, and suPAR) were associated with both all-cause and cardiovascular mortality. In the multivariate model, only NT-proBNP, suPAR, and MAGGIC score remained independent predictors of all-cause mortality as well as of cardiovascular mortality. Risk classification analysis was significantly improved with the addition of suPAR particularly for all-cause short- and long-term mortality. Using a classification tree approach, the same three variables could be considered as significant classifier variables to predict all-cause or cardiovascular mortality and an algorithm were reported. We demonstrated the favorable outcome associated with patients with a low MAGGIC score and a low suPAR level by comparison to patients with low MAGGIC score but high suPAR values.


The main findings of our study are (1) that among the three inflammatory biomarkers, only suPAR levels were independently associated with 96-month mortality for patients with chronic HF and (2) that an algorithm based on clinical score, a cardiomyocyte stress biomarker and an inflammatory biomarker could help to a more reliable long term risk stratification in heart failure.

Corresponding author: Jean Paul Cristol, Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier cédex 534295, France; and PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France, Fax: +33 4 67 33 83 93, E-mail:


The suPAR Assay was provided by Virogates, Birkerød, Danemark.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.


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Supplementary Material

The online version of this article offers supplementary material

Received: 2020-06-12
Accepted: 2021-01-22
Published Online: 2021-02-04
Published in Print: 2021-06-25

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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