{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:15:42Z","timestamp":1765880142449,"version":"3.48.0"},"reference-count":49,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T00:00:00Z","timestamp":1765670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Postoperative organ complications following open thoracoabdominal aortic aneurysm (TAAA) repair pose significant challenges during the early postoperative period, where prompt detection is crucial for improving patient outcomes. Sepsis is often a central factor in these complications. This study investigates the perioperative dynamics of soluble urokinase plasminogen activator receptor (suPAR) plasma levels in TAAA patients undergoing elective surgical repair and evaluates its diagnostic potential for early detection of postoperative sepsis. Methods: In this retrospective, single-center study, 28 patients (mean age 52.6 \u00b1 13.4 years; 67.9% male) underwent elective open TAAA repair between 2022 and 2024. Blood samples were collected at five perioperative time points, and suPAR levels were measured using ELISA. The primary endpoint was the onset of postoperative sepsis, with secondary endpoints including other organ complications. The predictive performance of suPAR levels was evaluated using Receiver Operator Characteristics (ROC) analysis. Results: Postoperative sepsis developed in 7 of 28 patients (25%), with the diagnostic criteria met at a mean of 9.7 \u00b1 6.9 days. Baseline suPAR levels did not differ between groups; however, from 12 h after surgery, the sepsis group exhibited significantly higher serum concentrations (14.43 ng\/mL vs. 7.23 ng\/mL; p = 0.004), a difference that persisted throughout the first 24 h. At 24 h, suPAR had the highest predictive accuracy for sepsis, with an AUC of 0.90, 90% sensitivity, and 86% specificity at a 9 ng\/mL cut-off (p &lt; 0.001). Conclusions: Elevated suPAR levels in the early postoperative period are strongly associated with the later onset of sepsis. Early monitoring may enable timely intervention, potentially improving outcomes in this high-risk patient population.<\/jats:p>","DOI":"10.3390\/jcm14248843","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:57:24Z","timestamp":1765879044000},"page":"8843","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Increased suPAR Plasma Levels May Indicate Postoperative Sepsis Following Open Thoracoabdominal Aortic Repair"],"prefix":"10.3390","volume":"14","author":[{"given":"Dragos","family":"Socol","sequence":"first","affiliation":[{"name":"Faculty of Medicine, RWTH Aachen University, Campus Aachen, 52062 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathryn","family":"Bassett","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7497-1858","authenticated-orcid":false,"given":"Bernhard","family":"Hruschka","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8416-4624","authenticated-orcid":false,"given":"Jelle","family":"Frankort","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moustafa","family":"Elfeky","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7381-5035","authenticated-orcid":false,"given":"Katja","family":"Heller","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Kahles","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I\u2014Cardiology, University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1313-152X","authenticated-orcid":false,"given":"Berkan","family":"Kurt","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I\u2014Cardiology, University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Uhl","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4876-4873","authenticated-orcid":false,"given":"Panagiotis","family":"Doukas","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8451-2913","authenticated-orcid":false,"given":"Alexander","family":"Gombert","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ejvs.2021.03.034","article-title":"Editor\u2019s Choice-Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010\u20132016","volume":"62","author":"Boyle","year":"2021","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.ejvs.2019.10.016","article-title":"Editor\u2019s Choice-European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections","volume":"59","author":"Chakfe","year":"2020","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/j.ejvs.2022.02.003","article-title":"Outcome of Elective and Emergency Open Thoraco-Abdominal Aortic Aneurysm Repair in 255 Cases: A Retrospective Single Centre Study","volume":"63","author":"Gombert","year":"2022","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1001\/jamasurg.2023.2128","article-title":"Outcomes After Endovascular Aortic Intervention in Patients with Connective Tissue Disease","volume":"158","author":"Olsson","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/j.jvs.2021.09.021","article-title":"Risk factors associated with long-term mortality and complications after thoracoabdominal aortic aneurysm repair","volume":"75","author":"Rocha","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.jtcvs.2015.12.050","article-title":"Outcomes of 3309 thoracoabdominal aortic aneurysm repairs","volume":"151","author":"Coselli","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1097\/CCM.0000000000003342","article-title":"Epidemiology and Costs of Sepsis in the United States-An Analysis Based on Timing of Diagnosis and Severity Level","volume":"46","author":"Paoli","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"12795","DOI":"10.1038\/s41598-024-63412-1","article-title":"Postoperative bioactive adrenomedullin is associated with the onset of ARDS and adverse outcomes in patients undergoing open thoracoabdominal aortic surgery","volume":"14","author":"Doukas","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1024\/0301-1526\/a000736","article-title":"Comparison of urine and serum neutrophil gelatinase-associated lipocalin after open and endovascular thoraco-abdominal aortic surgery and their meaning as indicators of acute kidney injury","volume":"48","author":"Gombert","year":"2019","journal-title":"Vasa"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Doukas, P., Bassett, C., Krabbe, H., Frankort, J., Jacobs, M.J., Elfeky, M., and Gombert, A. (2023). IFABP levels predict visceral malperfusion in the first hours after open thoracoabdominal aortic repair. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1200967"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1097\/SHK.0000000000001434","article-title":"The Diagnostic and Prognostic Value of suPAR in Patients with Sepsis: A Systematic Review and Meta-Analysis","volume":"53","author":"Huang","year":"2020","journal-title":"Shock"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Rasmussen, L.J.H., Petersen, J.E.V., and Eugen-Olsen, J. (2021). Soluble Urokinase Plasminogen Activator Receptor (suPAR) as a Biomarker of Systemic Chronic Inflammation. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.780641"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"871","DOI":"10.7754\/Clin.Lab.2017.170110","article-title":"Prognostic Role of Circulating Soluble uPAR in Various Cancers: A Systematic Review and Meta-Analysis","volume":"63","author":"Liu","year":"2017","journal-title":"Clin. Lab."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Manfredi, M., Van Hoovels, L., Benucci, M., De Luca, R., Coccia, C., Bernardini, P., Russo, E., Amedei, A., Guiducci, S., and Grossi, V. (2023). Soluble Urokinase Plasminogen Activator Receptor (suPAR) in Autoimmune Rheumatic and Non Rheumatic Diseases. J. Pers. Med., 13.","DOI":"10.3390\/jpm13040688"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1016\/j.surg.2021.10.012","article-title":"Elevated preoperative suPAR is a strong and independent risk marker for postoperative complications in patients undergoing major noncardiac surgery (SPARSE)","volume":"171","author":"Chalkias","year":"2022","journal-title":"Surgery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5005\/jp-journals-10071-23105","article-title":"Role of C-reactive Protein as an Indicator for Determining the Outcome of Sepsis","volume":"23","author":"Anush","year":"2019","journal-title":"Indian. J. Crit. Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"23","DOI":"10.3109\/10408363.2013.764490","article-title":"Biomarkers of sepsis","volume":"50","author":"Faix","year":"2013","journal-title":"Crit. Rev. Clin. Lab. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/MS9.0000000000002791","article-title":"The dynamic role of soluble urokinase plasminogen activator receptor (suPAR) in monitoring coagulation dysfunction during COVID-19 progression: A review","volume":"87","author":"Obeagu","year":"2025","journal-title":"Ann. Med. Surg."},{"key":"ref_19","first-page":"1293","article-title":"suPAR: A New Biomarker for Cardiovascular Disease?","volume":"31","author":"Hodges","year":"2015","journal-title":"Can. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"100109","DOI":"10.1016\/j.jvsvi.2024.100109","article-title":"Contemporary operative strategies and technical nuances for open thoracoabdominal aortic aneurysm repair","volume":"2","author":"Frankort","year":"2024","journal-title":"JVS-Vasc. Insights"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.21037\/jovs.2018.01.12","article-title":"State-of the-art review on the renal and visceral protection during open thoracoabdominal aortic aneurysm repair","volume":"4","author":"Waked","year":"2018","journal-title":"J. Vis. Surg."},{"key":"ref_22","first-page":"49","article-title":"Surgical repair of thoracoabdominal aortic aneurysms","volume":"48","author":"Jacobs","year":"2007","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1067\/mva.2002.122024","article-title":"Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: Results of a randomized clinical trial","volume":"35","author":"Coselli","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"c179","DOI":"10.1159\/000339789","article-title":"KDIGO clinical practice guidelines for acute kidney injury","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron Clin. Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/S2213-2600(21)00105-3","article-title":"The Berlin definition of acute respiratory distress syndrome: Should patients receiving high-flow nasal oxygen be included?","volume":"9","author":"Matthay","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_27","first-page":"565","article-title":"Sepsis in the intensive care unit","volume":"33","author":"Bennett","year":"2015","journal-title":"Surgery"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1186\/s13054-020-02950-2","article-title":"Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019- results from a systematic review and meta-analysis","volume":"24","author":"Bauer","year":"2020","journal-title":"Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1186\/s13054-023-04492-9","article-title":"Efficacy of CytoSorb(R): A systematic review and meta-analysis","volume":"27","author":"Becker","year":"2023","journal-title":"Crit. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.thromres.2016.11.007","article-title":"Coagulation and sepsis","volume":"149","author":"Levi","year":"2017","journal-title":"Thromb. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1055\/s-0039-1694995","article-title":"Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulation","volume":"46","author":"Iba","year":"2020","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s00281-011-0285-5","article-title":"Endothelium-role in regulation of coagulation and inflammation","volume":"34","year":"2012","journal-title":"Semin. Immunopathol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Napolitano, F., Giudice, V., Selleri, C., and Montuori, N. (2023). Plasminogen System in the Pathophysiology of Sepsis: Upcoming Biomarkers. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241512376"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1172\/JCI82224","article-title":"Sepsis-induced immune dysfunction: Can immune therapies reduce mortality?","volume":"126","author":"Delano","year":"2016","journal-title":"J. Clin. Investig."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1080\/00365513.2021.1952483","article-title":"Blood suPAR, Th1 and Th17 cell may serve as potential biomarkers for elderly sepsis management","volume":"81","author":"Zhao","year":"2021","journal-title":"Scand. J. Clin. Lab. Investig."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1007\/s00134-013-3056-z","article-title":"Hospital mortality prognostication in sepsis using the new biomarkers suPAR and proADM in a single determination on ICU admission","volume":"39","author":"Suberviola","year":"2013","journal-title":"Intensive Care Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e25040","DOI":"10.1002\/jcla.25040","article-title":"The Role of Soluble Urokinase Plasminogen Activator Receptor (suPAR) as an Early Indicator of Mortality in Pediatric Septic Shock","volume":"38","author":"Turan","year":"2024","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"R63","DOI":"10.1186\/cc10037","article-title":"Circulating soluble urokinase plasminogen activator receptor is stably elevated during the first week of treatment in the intensive care unit and predicts mortality in critically ill patients","volume":"15","author":"Koch","year":"2011","journal-title":"Crit. Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1093\/icvts\/ivaa239","article-title":"Can soluble urokinase plasminogen receptor predict outcomes after cardiac surgery?","volume":"32","author":"McCall","year":"2021","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s11845-023-03385-8","article-title":"C-reactive protein and procalcitonin during course of sepsis and septic shock","volume":"193","author":"Schupp","year":"2024","journal-title":"Ir. J. Med. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.clinbiochem.2019.05.010","article-title":"Analytical, biochemical and clearance considerations of soluble urokinase plasminogen activator receptor (suPAR) in healthy individuals","volume":"69","author":"Appleby","year":"2019","journal-title":"Clin. Biochem."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1016\/j.molimm.2011.02.011","article-title":"Participation of the urokinase-type plasminogen activator receptor (uPAR) in neutrophil transendothelial migration","volume":"48","author":"Pliyev","year":"2011","journal-title":"Mol. Immunol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s40560-019-0381-5","article-title":"Neutrophils are a main source of circulating suPAR predicting outcome in critical illness","volume":"7","author":"Gussen","year":"2019","journal-title":"J. Intensive Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1111\/anae.16104","article-title":"Postoperative systemic inflammation after major abdominal surgery: Patient-centred outcomes","volume":"78","author":"Bain","year":"2023","journal-title":"Anaesthesia"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Jang, J.H., Choi, E., Kim, T., Yeo, H.J., Jeon, D., Kim, Y.S., and Cho, W.H. (2024). Navigating the Modern Landscape of Sepsis: Advances in Diagnosis and Treatment. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25137396"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/SHK.0000000000001010","article-title":"A Novel Combination of Biomarkers to Herald the Onset of Sepsis Prior to the Manifestation of Symptoms","volume":"49","author":"Dolin","year":"2018","journal-title":"Shock"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.kint.2019.05.026","article-title":"Acute kidney injury from sepsis: Current concepts, epidemiology, pathophysiology, prevention and treatment","volume":"96","author":"Peerapornratana","year":"2019","journal-title":"Kidney Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e165740","DOI":"10.1172\/jci.insight.165740","article-title":"suPAR links a dysregulated immune response to tissue inflammation and sepsis-induced acute kidney injury","volume":"8","author":"Nusshag","year":"2023","journal-title":"JCI Insight"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"4414","DOI":"10.1038\/s41467-023-40165-5","article-title":"SuPAR mediates viral response proteinuria by rapidly changing podocyte function","volume":"14","author":"Wei","year":"2023","journal-title":"Nat. Commun."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8843\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:12:28Z","timestamp":1765879948000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8843"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,14]]},"references-count":49,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248843"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248843","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,14]]}}}