European Journal of Orthopaedic Surgery & Traumatology · Mar 6, 2025

Soluble urokinase plasminogen activator receptor biomarker is not a predictor of mortality in high-risk hip fracture patients

By Avgerinos K, Katsanos S, Altsitzioglou P et al.

BACKGROUND: The soluble urokinase plasminogen activator receptor (SuPAR) is a biomarker of inflammation and immune activation that has been related with mortality in a vast spectrum of diseases in the elderly. Its prognostic value in preoperative evaluation for non-cardiac surgery has been promising. However, up to date there are no studies in high-risk patients undergoing hip fracture surgery. Therefore, we performed this prospective study aims to evaluate the prognostic value of SuPAR and other common clinical, echocardiographic, and blood biomarkers for the 1-year survival of high-risk hip fracture surgery patients. METHODS: We studied 46 patients with hip fracture that underwent hip fracture surgery from 2019 to 2024. There were 10 men and 36 women, over 65 years of age (mean, 85 ± 8 years) with at least one high-risk characteristic (dementia, chronic immobilization, age > 90 years). Upon admission, complete clinical and laboratory assessments, including electrocardiogram and cardiac ultrasonography, radiographs, and blood sampling, were conducted. Serum blood levels of SuPAR as well as natriuretic peptides and troponin I were measured. The Katz index of frailty was calculated. The patients were followed for 1 year after admission and hip fracture surgery. At that time, the patients or their relatives were contacted through telephone, and their 1-year survival was documented. RESULTS: Overall, 25 (54.3%) patients were dead at 1-year examination. There was no significant difference in baseline values of SuPAR between patients dead or alive at follow-up (6.30 ng/dl [range, 4.95-7.05 ng/dl] vs. 6.25 ng/dl [4.25-9.05 ng/dl], respectively; p value = 0.767), and SuPAR has not been related to 1-year mortality (HR 0.802; 95% CI 0.248-2.595; p value = 0.712). The only univariate and multivariate predictors of survival were age (HR 1.098; 95% CI 1.003-1.181; p = 0.041) and Katz index ≤ 4 (HR 4.490; 95% CI 1.180-17.093; p = 0.028). CONCLUSION: This study showed that SuPAR is not a predictive factor for 1-year mortality in high-risk patients undergoing hip fracture surgery. Older age and Katz index score ≤ 4 were the only independent predictors of 1-year mortality. Therefore, although no definite conclusion can be drawn from such a small number of patients, no trend in mortality for this measurement has been observed, suggesting SuPAR and similar biomarkers should not be considered in the evaluation of mortality in high-risk hip fracture patients.

doi.org/10.1007/s00590-025-04211-w Open access, accepted manuscript PubMed 40047907 Biomarkers