Plasma levels of soluble urokinase plasminogen activator receptor (suPAR) and high-sensitivity C-reactive protein after Roux-en-Y gastric bypass or sleeve gastrectomy: a 1-year prospective observational study

Abstract

Purpose Low-grade inflammation in obesity contributes to the development of cardiovascular disease, diabetes mellitus and cancer, and is associated with increased mortality. The purpose of this 1-year prospective observational study was to examine the weight loss effect of bariatric surgery on plasma concentrations of two inflammatory markers, namely high-sensitivity C-reactive protein (hsCRP) and soluble urokinase-type plasminogen activator receptor (suPAR), in patients with obesity. Methods Sixteen subjects without obesity and 32 patients with obesity class III, who had already settled upon Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were included in the study. Subjects without obesity were examined once, at baseline; patients with obesity were examined preoperatively (baseline) and 3, 6 and 12 months postoperatively. Results Plasma suPAR and hsCRP concentrations at baseline were higher in patients with obesity than in lean participants (2.68 +/- 0.86 vs 1.86 +/- 0.34 ng/mL,p < 0.001 and 9.83 +/- 9.55 vs 1.36 +/- 1.95 mg/dL,p < 0.001). Levels of suPAR following bariatric surgery increased significantly 3 months after either RYGB or SG (3.58 +/- 1.58 vs 3.26 +/- 0.7 ng/mL, respectively) and declined at 6 (3.19 +/- 1.75 vs 2.8 +/- 0.84 ng/mL, respectively) and 12 months (2.6 +/- 1.5 vs 2.22 +/- 0.49 ng/mL, respectively;p < 0.05 for the effect of time on suPAR levels during the study), whereas those of hsCRP declined consistently after bariatric surgery (3 months: 5.44 +/- 3.99 vs 9.47 +/- 11.98 mg/dL, respectively; 6 months; 5.39 +/- 5.6 vs 10.25 +/- 17.22 mg/dL, respectively; and 12 months: 2.23 +/- 2.5 vs 3.07 +/- 3.63 mg/dL, respectively;p < 0.001 for the effect of time on hsCRP levels during the study). 1-year change in BMI was negatively associated with suPAR levels at 12 months. Conclusion Our findings support an association between obesity and low-grade inflammation. Weight loss following bariatric surgery is associated with a consistent decline in plasma hsCRP, while plasma suPAR levels increase at 3 months and decline by 12 months.