Soluble urokinase plasminogen activator receptor and perioperative complications: a systematic review.

BACKGROUND: Better informative predictive tools are required to improve risk-stratification in patients undergoing surgery. Soluble urokinase-type plasminogen activator receptor (suPAR) has the potential to predict postoperative complications. The primary objective of this systematic review was to evaluate the association between suPAR measured around the time of surgery and perioperative complications. METHODS: We systematically reviewed studies indexed in Embase or PubMed from inception up to October 8, 2024. We included studies evaluating the association between suPAR measured around surgery and perioperative complications captured up to 90 days after surgery. We excluded case reports, reviews, editorials, studies with non-human participants, and clinical practice guidelines. We used the Quality in Prognostic Studies tool to assess the risk of bias, and Grading of Recommendations Assessment, Development and Evaluation to ascertain the certainty in the inference for reported associations. RESULTS: Eighteen of the 19 included studies provided evaluable data from 6410 patients on the association between suPAR and perioperative outcomes. There was moderate certainty that suPAR associates with acute kidney injury, low certainty of association with mortality, very low certainty of association with composites of multiple complications, resource utilization outcomes, and infectious complications. However, we were highly uncertain about the magnitude of association because studies were heterogeneous, poorly reported, mostly retrospective, and too small to provide robust estimates. CONCLUSIONS: We conclude that serum or plasma concentrations of suPAR measured around surgery is likely associated with perioperative complications, especially acute kidney injury. The magnitude of these associations and the clinical value of suPAR should now be compared to other clinical information and prognostic biomarkers in biobanks of large prospective studies.